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Expanded Q and A From HBV Live
Expanded Q&A From HBV Live! A Deep Dive Into the Evolving Landscape of Hepatitis B Management

Released: May 26, 2026

Jordan J. Feld
Jordan J. Feld, MD, MPH
Mark Sulkowski
Mark Sulkowski, MD, FAASLD
Norah Terrault
Norah Terrault, MD, MPH
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Key Takeaways
  • Knowing a patient’s quantitative HBsAg may help guide future shared decision-making conversations about new treatments. 
  • For people who do not respond to the HBV vaccine, or whose responses waned over time, evidence shows that repeat HBV vaccination with 2 or 3 doses of HepB-CpG (0 and 1 month or 0, 1, and 6 months) is more effective than repeating vaccination with the standard 3-dose HepB-alum regimen.

In this commentary, a panel of healthcare professionals (HCPs) answers audience questions from a symposium on hepatitis B prevention and management. [Coder link to: https://deceraclinical.com/education/program/infectious-disease/hbv-management/57776]

A point-of-care hepatitis B virus (HBV) test would likely help to increase HBV screening. What are the panelists' thoughts on that, and where are we in the US in getting this FDA approved?

Jordan Feld, MD:
I agree, and I wish we had a point-of-care HBV test. It would be helpful both for screening for HBV and for lowering the barrier to hepatitis C virus treatment by enabling HCPs to perform HBV testing at hepatitis C virus treatment initiation. [Coder link to: https://deceraclinical.com/education/program/hbv-in-key-communities/55731]

Although there are point-of-care HBV tests globally, none are currently approved in the US. My understanding is that this may be in the process of changing, but I'm not sure of a timeline.

Do you check genotype and mutation status on all patients with positive HBsAg?

Norah Terrault, MD:
In my practice, we are silent on that because we don't think that testing has a role to play at this time. For example, with the current nucleoside analog therapy, there's no differential response based on genotype, so genotyping is not currently recommended as part of routine management of patients with chronic hepatitis B. [Coder link to: https://deceraclinical.com/education/activities/infectious-disease/hbv-management-2/159103/content]

How frequently do you check the quantitative hepatitis B surface antigen (HBsAg) for patients not on treatment or those treated with nucleoside analogs? 

Mark Sulkowski, MD:
Unlike monitoring HBV DNA and alanine aminotransferase, there is no definitive recommendation or guidance from the American Association for the Study of Liver Diseases on the optimal frequency of monitoring quantitative HBsAg. Although quantitative HBsAg is often done at baseline, HBV DNA and alanine aminotransferase are still the gold standard for monitoring.

However, there is consensus among the panel about how we use quantitative HBsAg in clinical practice. HCPs should test patients when they initially present for care and then test annually to understand any trends in the HBsAg levels. 

Personally, I’m also planning to repeat testing on many of my patients in Fall 2026, in anticipation of the ability to engage in shared decision-making around new treatments for patients with low levels of HBsAg (<3000 IU/mL). This will also be helpful for patients with higher HBsAg levels, to explain why the new treatments are not expected to be effective for them.

How are you managing patients who did not respond to the 3-dose HBV vaccine?  

Mark Sulkowski, MD:
Let me first break this group into 2 categories. The first category is individuals who complete the recommended 3-dose vaccine series with immunizations at 0, 1, and 6 months, and who underwent testing for hepatitis B surface antibody (anti-HBs) titers 1-2 months after completing the series. This is the recommended assessment for vaccine responsiveness.

In this group, people with anti-HBs titers <10 mIU/mL are considered to be HBV vaccine nonresponders. Of course, people with active HBV infection won’t respond to the vaccine, so you should be sure to check HBsAg too.

In healthy individuals, the nonresponse rate is approximately 5% to 15%, but it can be significantly higher in older people and those who smoke, have diabetes, HIV, or renal disease requiring dialysis, or are immunosuppressed. 

The second category is people who are tested for anti-HBs titers later. In the real world, many people are not assessed after completion of the series, but they are later found to be anti-HBs negative. This group is more heterogenous, including people who were nonresponsive to vaccination and those who responded and have waning titers over time.  

Based on the results of the BEe-HIVe study published in JAMA, my approach for vaccine nonresponders is to repeat HBV vaccination with HepB-CpG given as 2 doses (0 and 1 month) or 3 doses (0, 1, and 6 months).

In this randomized, controlled trial, people with HIV and negative anti-HBs titers despite prior vaccination were revaccinated with either 2 or 3 doses of HepB-CpG, or the standard 3-dose HepB-alum regimen. The results showed that 2 doses of HepB-CpG or 3 doses of HepB-CpG were more effective than repeating the standard 3-dose HepB-alum regimen.

Of course, when repeating the vaccine, I strive to check anti-HBs titers at 1-2 months after completing the regimen. [Coder link to: https://deceraclinical.com/education/activities/infectious-disease/hepatitis-a-and-b-prevention/152602/content]

Your Thoughts
What other questions do you have about HBV prevention or management that weren’t answered here? Does your approach to monitoring quantitative HBsAg or managing vaccine nonresponders differ from what is described here? Leave a comment to join the discussion.

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