Hep B Blog

Doctors Get a New Tool to Improve Hepatitis B Treatment and Monitoring

Photo courtesy of CDC.
Photo courtesy of CDC.

By Christine Kukka

A recently-approved test now allows doctors to measure exactly how much hepatitis B surface antigen (HBsAg) people with chronic hepatitis B have in their blood; so why should patients get this test and how will it help the millions of people around the world infected with hepatitis B?

According to experts, including the Hepatitis B Foundation’s Medical Director Robert Gish, knowing a patient’s HBsAg levels gives doctors:

  • A better understanding of what stage of hepatitis B a patient is in;
  • A more accurate assessment of a patient’s liver cancer risk; and
  • Essential information to judge if it’s time to start or stop treatment.

And in the future, this test may be critical to finding a cure.

Don’t labs already test for HBsAg? HBsAg, the protein that makes up the surface of the virus, is what labs look for in a blood sample to determine if a person is currently infected with hepatitis B.

Historically, labs determined only if HBsAg was present or not, which is why patients either tested positive or negative for HBsAg. Recently, countries outside the U.S. began measuring HBsAg quantities in blood samples and late last year became available in the U.S. as a federally-approved (CLIA) lab test from Quest Diagnostics.

Hepatitis B Foundation President Timothy Block
Hepatitis B Foundation President Timothy Block

“The strange thing about HBsAg, is that each hepatitis B virus requires only about 100 HBsAg molecules to provide its envelope protein, but the virus produces about 100- to 1 million-times more HBsAg than is needed, leaving millions of HBsAg circulating in the bloodstream,” explained Timothy Block, president of the Hepatitis B Foundation and the Baruch S. Blumberg Institute, the foundation’s research arm.

That over-abundance of HBsAg is why people continue to test positive for HBsAg even if they have an undetectable viral load (HBV DNA).

Why is there so much HBsAg? Researchers, including Block, suspect that in addition to covering the virus’ surface, HBsAg also serves as a decoy to “exhaust” or deflect our immune system’s:

  • T-cells, so they can’t attach to and attack the virus,
  • And B-cells, so they don’t generate the antibodies needed to destroy the viral antigens that make up the virus.

So when HBsAg levels decline–either due to treatment or a strong immune response to the infection–researchers know a patient is on the road to clearing the infection. Bottom line: A low or undetectable HBsAg level means patients are winning the war against hepatitis B and their risk of liver damage is greatly reduced. 

When should doctors measure HBsAg? According to Quest Diagnostics, which created the test, measuring HBsAg levels better identifies which patients are at risk of hepatitis B reactivation.

For example, a patient may be HBeAg-negative and have normal liver enzymes (ALT/SGPT) that indicate a liver is “healthy,” but if HBsAg remain high, doctors know a patient remains at risk of reactivation and hasn’t really entered the safer, “inactive” stage.

Quest maintains that measuring HBsAg and viral load (HBV DNA) together, “…improves the ability to differentiate the phases in HBeAg-negative patients and HBeAg-positive disease and results in a diagnostic accuracy of 70 to 94 percent.

According to Quest, patients with HBV genotype B or C who have low HBV DNA levels (less than 2,000 IU/mL) and HBsAg levels below 1,000 IU/mL have lower risk of liver damage and cancer. In fact, if HBsAg is under 100 IU/mL, patients may be on their way to clearing HBsAg from their blood.

Dr. Robert Gish
Dr. Robert Gish

Knowing for sure when treatment is working: HBsAg levels also reflect the amount of virus protein produced by infected liver cells and if treatment is effectively stopping the virus from producing these proteins. If a patient is treated with pegylated interferon, a decline in HBsAg during the first 12 weeks indicates a successful response to the drug. No change in HBsAg levels indicates interferon will not be effective.

HBsAg changes may also determine if antivirals are working. “In HBeAg-negative patients, low (HBsAg) levels at the end of treatment are associated with sustained virologic response,” Quest officials noted.

If patients have been treated with antivirals for many months or years and achieve undetectable viral load and low HBsAg levels, doctors may consider taking them off the drug.

Dr. Gish considers this new test an essential tool that providers should employ and patients should ask for to get an accurate picture of their infection state and liver cancer risk.

“I use it today to determine when to start treatment, assess a patient’s prognosis while on treatment, enhance patient compliance and determine when treatment can be stopped or should be continued,” he explained. “And this will also be an extremely helpful tool for drug developers in the future to identify promising treatments.”

Because lowering or eradicating HBsAg appears essential to stopping chronic infection and empowering the immune system to fight this complex infection, researchers around the world are working to develop treatments that inhibit HBsAg.

“I am a big believer in finding drugs that suppress HBsAg,” Dr. Block noted. Two of these surface antigen eradicator products are currently in Phase II trials.

Comments on this blog are closed. If you have questions about hepatitis B or this blog post, please email info@hepb.org or call 215-489-4900.

22 thoughts on “Doctors Get a New Tool to Improve Hepatitis B Treatment and Monitoring”

  1. Hi sir/mam!im female and im reactive of HBsAg,I noticed that i have this last year of october.when i undergo of medical for applying wrk abroad but sad to say my result that i have hepa,is there any cure??or do ihave possibility it will clear??

    1. Hello: There currently is no cure for hepatitis B, but there are effective treatments if you should ever experience any liver damage.
      Keep in mind that not everyone with hepatitis B requires treatment, many people live long and healthy lives with hepatitis B. Generally, medical guidelines recommend treatment only if you are experiencing liver damage. This is indicated by an ultrasound and a simple blood test for the liver enzyme ALT (also called SGPT). Our liver cells release ALT when they are damaged or die. Healthy ALT levels for men are up to 30, and for women they are up to 19. Please consult with your doctor and see what your ALT levels are to determine if you require treatment.
      If you ever do, there are two very effective antiviral medications that are recommended: tenofovir (Viread) and entecavir.
      If this is the first time you have ever been tested for hepatitis B, wait six months and get tested again. If you were recently infected, generally the immune system is able to cure it in six months. If you were infected at birth or during childhood, you will continue to test positive for the hepatitis B surface antigen (HBsAg) and have chronic hepatitis B. Good luck.

  2. What the name of this test: “A recently-approved test now allows doctors to measure exactly how much hepatitis B surface antigen (HBsAg) people with chronic hepatitis B have in their blood;”

    I would like to ask my doctor to order it for me the next time I see him.


  3. A very timely article. In Australia, as well as in America, this test is not yet routinely offered to HBV patients, even though the test has been available in Europe and China for many years.

  4. hello sir,
    I have hep B & D, cirohhus . QHBsAg 17645ml, HBV-102 COPIES ML, it was result of 2014. since that i unable to get lab test again, can you give me adivce.
    i have heard new drug for hep d is discovered in USA, is that can completely cure hep d?

    1. Hello: I’m sorry to hear of your hepatitis B and D, and your cirrhosis.
      At this time, there is no cure for hepatitis D. There is one treatment currently being used for hepatitis D patients, pegylated interferon, which has shown to suppress the virus in about 30 percent of patients. The good news is there are five promising new drugs in development, and many more treatment options are expected in the coming years. Read more about treatments and drugs in the pipeline here: http://www.hepb.org/research-and-programs/hepdeltaconnect/treatment/
      If you want to consider joining a clinical trial for these new treatments, please visit our Clinical Trials page for more information: http://www.hepb.org/research-and-programs/hepdeltaconnect/clinical-trials/.
      For more information, resources and support, please check out our new website for hepatitis D patients: http://www.hepdconnect.org and find us on Twitter (www.twitter.com/hepdconnect), Facebook (www.facebook.com/hepdconnect) and Instagram (@hepdconnect)
      There is hope on the horizon! Follow us on social media for the most up to date information on hepatitis D and keep staying positive.
      Good luck.

  5. Hello Dr
    Is it possible for an acute hepatitis b infection to be mistaken for a chronic infection. I was tested positive few weeks ago and because I have a nonreactive IgM and a reactive IgG my doctor concluded I’m at chronic stage of the infection, also a nonreactive Hbeag my ALP is very normal. In most articles I’ve read to determine if its chronic one has to wait for 6 months. Why does one have to wait for six months if a diagnostic test cant tell the accurate stage of the infection?

    1. Hello: When you test positive for the hepatitis B surface antigen (HBsAG), it means you are currently infected with hepatitis B. As you mentioned, most healthy adults who are infected are able to get rid of the virus on their own within six months. This is called an acute infection. It simply takes that long for the immune system to generate the antibodies needed to eradicate the viral antigens and for T cells to destroy the infected liver cells.
      If you continue to test positive for HBsAg for longer than six months, it is considered a chronic infection. It means you were probably infected at birth or during early childhood, when your immature immune system could not recognize and fight it.
      Knowing whether your hepatitis B is acute or chronic will help you and your doctor determine your next steps. Please get tested again in six months to find out if it’s chronic or acute. If you are unsure of what your blood test results mean, please visit: http://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-blood-tests/
      Good luck.

    1. Hello: That is excellent news that your hepatitis B surface antigen (HBsAg) level is low. As noted in the blog, “… if HBsAg is under 100 IU/mL, patients may be on their way to clearing HBsAg from their blood.” Keep eating healthy foods, avoid alcohol and cigarettes, and get monitored regularly. Good luck!!!

  6. hi doctor I have a lot of pain in my right ribs and stomach. Have chronic Hep b so please what can I do to release myself from this pain

    1. Hello: The liver has very few sensory nerves around it, so it’s actually unusual to experience abdominal pain from a hepatitis B infection. It is why it’s called the silent infection. The pain you are experiencing may result from another medical condition that is not related to hepatitis B. Please see your doctor and describe your symptoms. For more information on abdominal pain and hepatitis B, please read: https://www.hepb.org/blog/when-is-that-pain-hep-b-related-and-when-is-it-something-else/
      Good luck.

  7. This is very informative. I have been taking Viread 300MG daily for 6 years with undetectable DNA levels. Unfortunately my latest HBsAg level is still at about 4,000. Is there anything else I can do besides Viread? Thanks.

    1. Hello: Unfortunately, antivirals reduce the amount of the virus in your body, but do not appear able to reduce the amount of hepatitis B surface antigen (HBsAg) in your body. Unfortunately, that is what makes hepatitis B so challenging to cure. It will be interesting in the months and years ahead to find out if TAF (tenofovir alafenamide), the new formulation of tenofovir, is better able to reduce HBsAg because it reaches liver cells more efficiently. Stay tuned!!! Good luck.

  8. Hi I’m Garry from Philippines. I’d like to ask how long jaundice go away? I cannot go to my work because of my condition I was diagnose for hepatitis B.

    please I need your help.

    1. Hello: Acute hepatitis B symptoms can last several weeks. Aside from feeling self-conscious, there is no reason for you not to go to work because of your jaundice, unless you are feeling ill and are unable to work.
      Also, please make sure you are tested again for hepatitis B in six months to see if it is indeed an acute case. When healthy adults are infected, it can take up to six months for the immune system to clear out the infection and for you to develop hepatitis B surface antibodies (anti-HBs). Good luck.


    1. Hello: Fatty liver disease is caused by fat-build-up in the liver resulting from obesity and too much fat in your diet. It does not result from hepatitis B, however when someone has both a hepatitis B infection and fatty liver disease, the combination can accelerate liver damage.
      Try to eat healthy foods, including low-fat protein and lots of fruits and vegetables, and get exercise in order to lose weight and reduce the amount of fat in your liver.
      Also, avoid alcohol and cigarettes.
      Your abdominal pain may be resulting from a medical condition other than hepatitis B. Please talk to your doctor about it, and for more information about hepatitis B and abdominal pain, please read: https://www.hepb.org/blog/when-is-that-pain-hep-b-related-and-when-is-it-something-else/
      Good luck.

  10. My husband he is 41 years old and has Hepb. He is on viread for past 7 years. We had never done the quantitative test before. However on the blood test report of 3/15/2016 I see the below results-

    Hepatitis B Surface Antigen- Reactive H
    Hepatitis B Surface Antigen Index- >1000 H
    Hepatitis B CoreAntibody Total- Reactive H
    Hepatitis Be Antibody- Positive H

    Hepatitis Be Antigen- Nonreactive
    Hepatitis B Surface Antibody- Non reactive
    HBV DNA not detected
    HBV DNA- <1.30
    Hep B Virus DNA- 1000 indicate abnormal count above 1000 or does it assumes that the count is above 1000 since the HBsAG is reactive? Like I said we had never ordered quantitative test of HBsAG, but the blood test that we had done in the past indicated above result.

    We will request this test next time on doctor’s visit.

    Thanks for making us aware of this new test.

    1. Hello: Actually your doctor range the hepatitis B surface antigen (HBsAg) test, and it is 1,000, which is moderately high.
      However, the good news is that your husband has an undetectable viral load (HBV DNA), probably as a result of his tenofovir (Viread) treatment.
      You didn’t mention it, but I hope his liver enzyme test (ALT or SGPT) and liver ultrasound have revealed no liver damage.
      Good luck.

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