Old and New Diagnostic Tools in the Management of Chronic HBV
Old and New Diagnostic Tools in the Management of Chronic HBV
We currently have a wide array of tools to investigate, diagnose and for monitoring hepatitis B.
Unfortunately, there are still physicians who are unable to rationally manage the use of the different serological and virological markers.
Identifying the sequence of events that allow physicians to accurately select the appropriate combination of diagnosis tools will help to take us an adequate care of the cost-benefit ratios.
Hepatitis B virus DNA serum quantification is the most accurate and powerful tool to help decision-making and to monitor the response to treatment. Furthermore, this method has shown a high sensitivity to both assess HBV behaviour in the natural history and predict (based on its plasma levels) any eventual and serious complication as cirrhosis and HCC.
The use of quantitative HBsAg has been proven really helpful as a tool to predict response to treatment and HBsAg loss. Plasma HBsAg reflects the transcriptional activity from cccDNA (covalently closed circular DNA) to messenger RNA. Its activity depends on a complex balance between HBV infection and host immune system.
Variation in serum HBsAg levels associated with HBV DNA determination is a useful combined tool for the characterization of the different phases of the viral chronic disease. The association of this resource with the determination of ALT levels usually helps choosing the candidate for treatment and differentiate the phase of inactive carrier from the development of a HBeAg-negative chronic hepatitis.
Although liver biopsy is still important for staging HBV disease, the advent of elastography has been regarded as a convenient alternative method in advanced stages of the disease. Its diagnostic accuracy for assessment of liver fibrosis has been demonstrated in patients with chronic viral hepatitis.
It is important to keep in mind that although transient elatography cannot completely abolish the need for liver biopsy, it can be used as an important non-invasive method which enables us to tailor a more efficient strategy for managing patients with chronic hepatitis B.
Over the past decade, we have been witnesses from an explosion of information and achievements on the evaluation and management of hepatitis B. These advances have been achieved by both the advent of new diagnostic tools and older tools which have been recategorized for new proposals. We simply should make a wise use of them.
Key Concepts and Conclusions
We currently have a wide array of tools to investigate, diagnose and for monitoring hepatitis B.
Unfortunately, there are still physicians who are unable to rationally manage the use of the different serological and virological markers.
Identifying the sequence of events that allow physicians to accurately select the appropriate combination of diagnosis tools will help to take us an adequate care of the cost-benefit ratios.
Hepatitis B virus DNA serum quantification is the most accurate and powerful tool to help decision-making and to monitor the response to treatment. Furthermore, this method has shown a high sensitivity to both assess HBV behaviour in the natural history and predict (based on its plasma levels) any eventual and serious complication as cirrhosis and HCC.
The use of quantitative HBsAg has been proven really helpful as a tool to predict response to treatment and HBsAg loss. Plasma HBsAg reflects the transcriptional activity from cccDNA (covalently closed circular DNA) to messenger RNA. Its activity depends on a complex balance between HBV infection and host immune system.
Variation in serum HBsAg levels associated with HBV DNA determination is a useful combined tool for the characterization of the different phases of the viral chronic disease. The association of this resource with the determination of ALT levels usually helps choosing the candidate for treatment and differentiate the phase of inactive carrier from the development of a HBeAg-negative chronic hepatitis.
Although liver biopsy is still important for staging HBV disease, the advent of elastography has been regarded as a convenient alternative method in advanced stages of the disease. Its diagnostic accuracy for assessment of liver fibrosis has been demonstrated in patients with chronic viral hepatitis.
It is important to keep in mind that although transient elatography cannot completely abolish the need for liver biopsy, it can be used as an important non-invasive method which enables us to tailor a more efficient strategy for managing patients with chronic hepatitis B.
Over the past decade, we have been witnesses from an explosion of information and achievements on the evaluation and management of hepatitis B. These advances have been achieved by both the advent of new diagnostic tools and older tools which have been recategorized for new proposals. We simply should make a wise use of them.