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World J Gastroenterol. Sep 14, 2014; 20(34): 12045-12055
Published online Sep 14, 2014. doi: 10.3748/wjg.v20.i34.12045
Practical approach in hepatitis B e antigen-negative individuals to identify treatment candidates
Ahmad Najib Azmi, Soek-Siam Tan, Rosmawati Mohamed
Ahmad Najib Azmi, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, 55100 Kuala Lumpur, Malaysia
Soek-Siam Tan, Department of Hepatology, Selayang Hospital, 68100 Selangor, Malaysia
Rosmawati Mohamed, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
Author contributions: Azmi AN, Tan SS and Mohamed R equally contributed to the present work; Azmi AN drafted, wrote, edited and revised the article; Tan SS and Mohamed R equally contributed to revise, edit and write the article; Mohamed R made the final critical review of article.
Correspondence to: Rosmawati Mohamed, MBBS, MRCP, MD, Professor, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. ros@ummc.edu.my
Telephone: +60-3-79492867 Fax: +60-3-79556936
Received: October 27, 2013
Revised: January 17, 2014
Accepted: April 8, 2014
Published online: September 14, 2014
Abstract

The natural history of chronic hepatitis B is characterized by different phases of infection, and patients may evolve from one phase to another or may revert to a previous phase. The hepatitis B e antigen (HBeAg)-negative form is the predominant infection worldwide, which consists of individuals with a range of viral replication and liver disease severity. Although alanine transaminase (ALT) remains the most accessible test available to clinicians for monitoring the liver disease status, further evaluations are required for some patients to assess if treatment is warranted. Guidance from practice guidelines together with thorough investigations and classifications of patients ensure recognition of who needs which level of care. This article aims to assist physicians in the assessment of HBeAg-negative individuals using liver biopsy or non-invasive tools such as hepatitis B s antigen quantification and transient elastography in addition to ALT and hepatitis B virus DNA, to identify who will remain stable, who will reactivate or at risk of disease progression hence will benefit from timely initiation of anti-viral therapy.

Keywords: Chronic hepatitis B, Hepatitis B e antigen-negative, Treatment candidates, Hepatitis B s antigen level, Nucleos(t)ides analogues, Pegylated interferon

Core tip: Hepatitis B e antigen (HBeAg)-negative, the predominant form of chronic hepatitis B infection worldwide, consist of individuals with varying levels of viral replication and liver disease. The dynamic nature of HBeAg-negative infection underscore the need for an appropriate classification and evaluation of this group of patients, including the use of additional tools such as transient elastography and hepatitis B s antigen quantification, with the aim of identifying potential candidates for treatment.