Non-invasive diagnosis and follow-up of chronic infection with hepatitis B virus

• Published in: Clinics and research in hepatology and gastroenterology Vol. 46; no. 8; p. 101773
• Main Authors: Leroy, Vincent, Chevaliez, Stéphane, Decraecker, Marie, Roulot, Dominique, Nana, Jean, Asselah, Tarik, Causse, Xavier, Durantel, David, Thibaut, Vincent, Ganne-Carrié, Nathalie, Bureau, Christophe, de Lédinghen, Victor, Bourlière, Marc
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.10.2022; Elsevier
• Subjects: Carcinoma, Hepatocellular; DNA, Viral; Follow-Up Studies; Hepatitis B e Antigens; Hepatitis B Surface Antigens; Hepatitis B virus; Hepatitis B virus - genetics; Hepatitis B, Chronic; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - diagnosis; Humans; Life Sciences; Liver Cirrhosis; Liver Cirrhosis - diagnosis; Liver Cirrhosis - etiology; Liver Neoplasms; Persistent Infection; RNA; RNA - therapeutic use; ab
• ISSN: 2210-7401; 2210-741X
• DOI: 10.1016/j.clinre.2021.101773

•Rapid diagnostic tests for HBV diagnosis are validated.•Initial work-up of chronic HBV infection should include HDV serology.•HBsAg quantification is a useful tool for initial staging and follow-up.•Non-invasive tests for liver fibrosis are validated with specific cut-offs.•PAGE-B risk-score is useful to engage hepatocellular carcinoma screening in non cirrhotics. Diagnosis of chronic hepatitis B virus (HBV) infection, initial staging of infection and monitoring of treated and untreated patients are mainly based on clinical, biological and imaging criteria allowing a complete non-invasive management for the majority of patients. Along to the conventional virological tools, rapid diagnostic tests and blotting paper tests for HBV DNA are validated alternatives. After diagnosis, the initial work-up should include HIV, HCV and HDV serologies, HBeAg status, and HBsAg and HBV DNA quantification. Assessment of severity (inflammation and fibrosis) is based on ALT serum levels and non-invasive evaluation of liver fibrosis by elastography or blood tests, which must be interpreted cautiously using specific cut-offs and taking into account ALT levels. Taken together, these parameters allow disease classification and treatment decision. Decision of hepatocellular carcinoma screening by ultra-sound every six months may be difficult in non-cirrhotic patients and the use of risk-scores such as PAGE-B is encouraged. Chronic HBV infection often has a dynamic and often unpredictable profile and regular monitoring is mandatory. In untreated patients, regular (3-12 months) follow-up should include ALT and HBV DNA serum levels. Periodical HBsAg quantification and non-invasive evaluation of liver fibrosis may refine disease outcome and prognosis. In treated patients, checking efficacy is mainly based on HBV DNA negativity. In patients with advanced fibrosis, evolution of liver stiffness can be useful for portal hypertension evaluation, but its improvement should not be considered to stop hepatocellular carcinoma screening. Finally, new parameters (HBV RNA, HBcrAg) are promising but their use is still restricted for research.