, Volume 9, Issue 4, pp 187-196

Hepatitis B Biomarkers: Clinical Significance of the Old and the New

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Abstract

Chronic hepatitis B is a dynamic disease with a very variable outcome ranging from mild, asymptomatic, nonprogressive disease to end-stage liver disease and/or hepatocellular carcinoma. Clinically significant endpoints take years or decades to develop and thus various biomarkers—ranging from clinical data to sophisticated virologic diagnostics—are used as surrogates for disease progression. Liver biopsy remains a robust indicator of disease severity; however, noninvasive markers may offer a useful alternative with some advantages. Clinical decisions are often made using alanine transaminase; however, it lacks adequate specificity to be used in isolation. Serologic markers (hepatitis B early antigen and hepatitis B surface antigen) provide information about the degree of immune control of viral replication, and thus remain important therapeutic indices. Sensitive measurement of serum hepatitis B virus DNA level is an indispensable biomarker. Its suppression is important, but only because it represents a bridge to more permanent stages of disease resolution. Newer assays, including hepatitis B surface antigen titers and hepatitis B genotyping, have therapeutic implications and are becoming more widely available. Clinicians caring for patients with chronic hepatitis B must be aware of the utility and limitations of available surrogate biomarkers.