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HBV in Key Communities

CE / CME

HBV in Key Communities: Strategies to Overcome Barriers and Elevate Care

Pharmacists: 0.75 contact hour (0.075 CEUs)

Physicians: maximum of 0.75 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 0.75 Nursing contact hour

Released: March 12, 2026

Expiration: March 11, 2027

Su Wang
Su Wang, MD, MPH, FACP
CME/CE Information

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Hep B Monitoring

Routine monitoring for HBV disease progression is important regardless of whether a patient is on treatment or not. I tell patients all the time, it doesn't matter if you're symptomatic or if your viral load is low because the disease is so dynamic. Your scenario can change without you feeling anything. Unless we do the blood test, we won't know if your HBV DNA or liver enzymes have changed. There are a lot of data showing that people are getting started on treatment too late, so consistent monitoring is key for timely treatment initiation.35,36,38,41

Ideally, I recommend that people with hepatitis B should have their ALT and HBV DNA assessed every 6 months, but it can range from every 3 months to a year.

It is also reasonable to get a surface antigen annually to monitor for seroclearance, especially for people with low HBV DNA who are on treatment.35,36,38,41

Based on the 2018 hepatitis B guidance, everyone with hepatitis B should have a 1-time test for hepatitis D virus (HDV). This represents a shift from risk-based HDV testing to universal screening.35

Another critical component of HBV monitoring is HCC surveillance. For those with increased risk, the AASLD guidelines recommend ultrasound and alpha-fetoprotein assessment every 6 months. High-risk groups include those with cirrhosis or a family history of HCC. The most recent guidelines also expand risk criteria to include people with HDV and/or HIV coinfection, men older than 40 years of age, and women older than 50 years of age who are from endemic regions.36,42-44

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What Can qHBsAg Be Used for in Clinical Practice?

Quantitative hepatitis B surface antigen testing (qHBsAg) is not covered in the AASLD guidelines, but it is a useful test that is becoming more common and easier to perform. This test can be ordered through commercial labs and provides additional data that I think is clinically useful for the management of HBV.

I find that qHBsAg has some prognostic value in terms of predicting liver fibrosis and the development of HCC. It can help identify people who are truly inactive HBV carriers among those with negative HBeAg in the “indeterminate phase.” It can also help monitor treatment responses and predict whether patients are candidates for stopping therapy by predicting off-treatment virologic control.45-47

In addition, qHBsAg can also determine the probability of HBsAg clearance. There is a higher probability of spontaneous clearance if qHBsAg <100 IU/mL.48

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Quantification of HBsAg in Patients With HBV DNA <20,000 IU/mL to Predict HCC

The REVEAL-HBV study demonstrates how HBsAg quantification can be used to predict HCC. A key takeaway of the study was that higher HBV DNA was associated with a greater risk of HCC.

With qHBsAg, further stratification within groups of people with the same viral load is possible. People with higher qHBsAg had higher rates of liver cancer despite similar levels of HBV DNA.49

I think these data are an important illustration of how qHBsAg can better inform HBV care. Even if a patient’s HBV DNA is on the low side, a higher qHBsAg may prompt consideration of treatment because of the association with increased HCC risk, at least in this group of patients who are HBeAg negative.

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