From the Guidelines
The presence of both HBsAg and anti-HBe indicates that you are in the inactive HBV carrier state, and as such, you should have regular monitoring with liver function tests and HBV DNA levels every 6 months to ensure the infection remains inactive, as recommended by the EASL clinical practice guidelines 1. This phase is characterized by very low or undetectable serum HBV DNA levels and normal serum aminotransferases. To confirm this state, a minimum follow-up of 1 year with alanine aminotransferase (ALT) levels at least every 3–4 months and serum HBV DNA levels is required 1. Some key points to consider in this state include:
- ALT levels should remain persistently within the normal range (approximately 40 IU/ml) 1
- HBV DNA should be below 2000 IU/ml 1
- Patients with HBV DNA <2000 IU/ml and elevated ALT values should undergo liver biopsy for the evaluation of the cause of liver injury 1
- Inactive HBV carriers have a favourable long-term outcome with a very low risk of cirrhosis or HCC in the majority of patients 1
- HBsAg loss and seroconversion to anti-HBs antibody may occur spontaneously in 1–3% of cases per year, usually after several years with persistently undetectable HBV DNA 1
- Progression to CHB, usually HBeAg-negative, may also occur 1 It is essential to distinguish true inactive HBV carriers from patients with active HBeAg negative CHB, as the former have a good prognosis with a very low risk of complications, while the latter have active liver disease with a high risk of progression to advanced hepatic fibrosis, cirrhosis, and subsequent complications 1. Regular monitoring and a healthy lifestyle, including avoidance of alcohol and maintenance of a healthy weight, are crucial in managing this condition. Additionally, family members and close contacts should be screened for Hepatitis B and vaccinated if not infected or immune.
From the Research
Hbsag Reactive and Anti HBe Reactive
- Hbsag reactive and anti HBe reactive indicate that the patient has a chronic hepatitis B infection and has developed antibodies against the hepatitis B e antigen (HBeAg) 2, 3.
- The presence of anti-HBe antibodies suggests that the patient has undergone HBeAg seroconversion, which is a critical event in the natural history of chronic hepatitis B infection 2, 3.
- HBeAg seroconversion is associated with a lower risk of disease progression to cirrhosis and hepatocellular carcinoma, and improved survival rates 3.
- The treatment of chronic hepatitis B infection aims to suppress viral replication, induce HBeAg seroconversion, and prevent disease progression 2, 3.
- Antiviral agents such as tenofovir and entecavir are effective in inducing HBeAg seroconversion and suppressing viral replication 4, 5.
- Combination therapy with pegylated interferon-α and nucleoside/nucleotide analogs may also be effective in reducing hepatitis B surface antigen (HBsAg) levels and inducing HBeAg seroconversion 6.
- The choice of treatment depends on various factors, including the patient's age, viral load, liver function, and presence of cirrhosis or hepatocellular carcinoma 2, 3.