4. HBVDNA Quantitation

An important component of the virus is DNA which contains the genetic material. During viral replication, DNA makes many copies of itself rapidly to assemble into new viruses. Thus, measuring the concentration of HBV-DNA in blood samples can determine the activity of the virus more accurately.

However, high blood level of HBV-DNA does not necessarily or invariably cause hepatitis. One example is young individuals in immune tolerant phase when the immune system is immature to response. The other example is in individuals with immuno-compromised state. Therefore, the interpretation of viral levels should take into consideration of the HBeAg positive and HBeAg negative status.

Patients with Positive HBeAg

HBeAg positivity indicates active HBV replication, usually associated with high blood HBV-DNA concentrations (>100,000 copies/ml) (in immune tolerant phase. Blood ALT level may be normal (in immune tolerant phase) or raised (in immune clearance phase).

Patients with Negative HBeAg

In general, concentrations of HBV-DNA in the blood of HBeAg negative patients are relatively low, thus HBV-DNA Quantitation and ALT level are both crucial indicators.

HBV-DNA Concentration	Recommendations
< 10copies/ml	Test ALT at 3 month intervals for first 3 times, then 6-12 month intervals if ALT still < 1X ULN.
10-10 copies/ml	Test ALT and check HBV-DNA at 3 month intervals. Consider biopsy if persistently raised ALT. Treatment as needed.
>10copies/ml	Treat if persistently raised ALT. Liver biopsy optional.

Other Blood Tests :

>HBeAg Test

>Liver Function Test (LFT)

>Alpha-Fetoprotein (AFP)

Other Tests :

>Ultrasound (U/S) / Computed Tomography (CT) / Magnetic Resonance Imagaing (MRI)

>Liver Biopsy

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