From the Guidelines
Hepatitis B e-antigen (HBeAg) should be checked at initial diagnosis, every 6-12 months in patients with persistently normal AST/ALT levels, and every 2-6 months if AST/ALT levels increase above the normal limit, as recommended by the most recent guidelines 1. When evaluating patients with chronic hepatitis B virus (HBV) infection, HBeAg should be tested alongside other markers like HBsAg, anti-HBe antibodies, and HBV DNA levels.
Key Points to Consider:
- HBeAg is typically checked in all newly diagnosed chronic HBV patients to determine disease phase and infectivity status.
- It should also be monitored every 3-6 months in patients on antiviral therapy to assess treatment response, with conversion from HBeAg-positive to HBeAg-negative (seroconversion) indicating successful immune control, as suggested by earlier guidelines 1.
- Additionally, HBeAg should be tested in pregnant women with HBV to assess transmission risk to the newborn, as HBeAg-positive mothers have higher viral loads and increased risk of vertical transmission.
- The presence of HBeAg generally indicates higher HBV DNA levels and greater risk of liver damage and disease transmission, highlighting its importance as a marker of active viral replication and higher infectivity.
Monitoring Frequency:
- In patients with compensated liver cirrhosis, liver function should be tested every 2-6 months, and serum HBV DNA should be measured by real-time PCR plus HBeAg status should be checked every 2-6 months 1.
- In patients with decompensated liver cirrhosis, liver function should be tested every 1-3 months, and serum HBV DNA should be measured by real-time PCR plus HBeAg status should be checked every 2-6 months 1.
From the Research
HBeAg Testing
- HBeAg (hepatitis B e-antigen) is a protein that is produced by the hepatitis B virus (HBV) and is often used as a marker of viral replication 2.
- The decision to check HBeAg status depends on various factors, including the patient's liver disease status, treatment history, and viral load 3.
- In patients with chronic hepatitis B, HBeAg testing can help determine the phase of the disease and guide treatment decisions 4.
Treatment Considerations
- Patients with HBeAg-positive chronic hepatitis B may benefit from treatment with interferon-α (IFN) or nucleos(t)ide analogues (NAs) 2.
- NAs, such as entecavir and tenofovir, are highly potent and have a low risk of resistance, but may require long-term or indefinite treatment [(2,4)].
- The decision to stop or continue treatment in HBeAg-positive patients who achieve stable HBeAg seroconversion should be made on a case-by-case basis, taking into account factors such as liver disease status and treatment history [(3,5)].
Monitoring and Follow-up
- Regular monitoring of HBeAg status, viral load, and liver function is essential for patients with chronic hepatitis B, regardless of treatment status [(4,6)].
- Patients with decompensated liver disease may require more frequent monitoring and adjustment of treatment as needed 6.