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Updated: Jun 5, 2026
Real-Time Polymerase Chain Reaction-Based Detection and Quantification of Hepatitis B Virus DNA
Published on: December 15, 2023
Assessment of chronic hepatitis B: the importance of hepatitis B virus DNA testing
C M N Croagh1, S J Bell, S Locarnini
1Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia. catherine.croagh@svhm.org.au
Insights
For chronic hepatitis B (CHB), alanine aminotransferase (ALT) levels do not reliably indicate hepatitis B virus (HBV) DNA replication in HBeAg-negative patients. Testing HBV DNA is crucial for accurate CHB evaluation and treatment decisions.
Area of Science:
- Hepatology
- Virology
- Internal Medicine
Background:
- Chronic hepatitis B (CHB) affects 90,000-160,000 Australians.
- CHB complications include cirrhosis and hepatocellular carcinoma.
- Evaluating hepatitis B surface antigen (HBsAg)-positive individuals is vital for identifying treatment candidates.
Purpose of the Study:
- To evaluate the correlation between HBV DNA and ALT levels in HBsAg-positive individuals.
- To determine the reliability of ALT as a marker for viral replication in CHB.
- To inform appropriate diagnostic strategies for HBeAg-negative CHB patients.
Main Methods:
- Cross-sectional evaluation of 348 HBsAg-positive individuals.
- Analysis of demographic, virological, serological, and biochemical data.
- Longitudinal follow-up of a subgroup of HBeAg-negative patients with normal ALT.
Main Results:
- 50% of patients were HBeAg-negative, chronic hepatitis phase.
- ALT and HBV DNA showed no correlation in HBeAg-positive CHB and weak correlation in HBeAg-negative CHB.
- 35% of HBeAg-negative patients with detectable HBV DNA had normal ALT; 38% with undetectable HBV DNA had elevated ALT.
Conclusions:
- Alanine aminotransferase (ALT) is not a reliable indicator of hepatitis B virus (HBV) replication in HBeAg-negative CHB.
- Hepatitis B e antigen (HBeAg)-negative chronic hepatitis B evaluation requires HBV DNA testing.
- Accurate assessment of viral replication is essential for guiding CHB treatment.
Background:
Chronic hepatitis B (CHB) has an estimated prevalence of 90 000 to 160 000 in Australia. Cirrhosis and hepatocellular carcinoma are important complications of CHB and appropriate evaluation of hepatitis B surface antigen (HBsAg)-positive individuals is vital to identify treatment candidates.
Methods:
A review of the database of a tertiary hospital was performed and 348 HBsAg-positive individuals with baseline demographic, virological, serological and biochemical variables were identified and evaluated cross-sectionally. A small subgroup of hepatitis B e antigen (HBeAg)-negative patients with normal alanine aminotransferase (ALT) at baseline were identified and followed longitudinally.
Results:
175/348 (50%) of patients were in the HBeAg-negative, chronic hepatitis phase of disease, 22% in the HBeAg-positive immune clearance and 6% in the immune tolerant phases. HBeAg-negative patients were older and more likely to be male than HBeAg-positive patients. The correlation between hepatitis B virus (HBV) DNA and ALT levels was examined. ALT and HBV DNA levels showed no correlation in HBeAg-positive CHB and only a weak correlation in HBeAg-negative patients. Furthermore, 35% of HBeAg-negative patients with detectable HBV DNA had a normal ALT. Conversely 38% of HBeAg-negative patients with no detectable HBV DNA had an elevated ALT. A persistently normal ALT over 24 months was seen in five of nine HBeAg-negative patients with normal initial ALT and detectable HBV DNA.
Conclusion:
Appropriate evaluation of HBeAg-negative CHB must include HBV DNA because the ALT is not a reliable guide to underlying viral replication.
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