You are about to leave a GSK website
By clicking this link, you will be taken to a website that is independent from GSK. The site you are linking to is not controlled or endorsed by GSK and GSK is not responsible for its content.
In chronic hepatitis B (CHB):
Comprehensive testing with key biomarkers allows for more clarity1-4
This clarity supports characterization of disease phase and severity, assessment of patient prognosis, and evaluation of treatment response:
KEY BIOMARKERS
HBV DNA
Quantitative HBsAg
Qualitative HBsAg
HBeAg
Anti-HBe antibodies
Full hepatic function panel:
ALT, AST, total bilirubin, +/- direct bilirubin, alkaline phosphatase, and albumin5
Noninvasive tests of fibrosis:
Serum APRI or FIB-4,* and elastography (vibration-controlled transient elastography, ultrasound, or MRI)5
For both cirrhotic and noncirrhotic patients, include HCC surveillance with ultrasound and alpha-fetoprotein.2,3
Chronic hepatitis B phases6
Figure used with permission. © 2018 Springer Nature. Yuen MF, et al. Hepatitis B virus infection. Nat Rev Dis Primers. 2018;4:18035. https://www.nature.com/articles/nrdp201835
AASLD† and EASL biomarker testing recommendations
While AASLD provides limited recommendations in specific patients, EASL updates acknowledge the value of, and recommend, qHBsAg testing.2,3
| AASLD (2016/2018/2025)3,4,7† | EASL (2025)2 | |
|---|---|---|
| HBV DNA | Every 3–6 months (or every 1–3 months if levels are 2,000–20,000 IU/mL during immune-tolerant phase) for patients not on therapy3,4 | Every 3–6 months for the first year following diagnosis, then every 6-12 months depending on disease phase for patients not on antiviral therapy |
| HBeAg | Every 6–12 months for patients not on therapy3 | Every 12 months in HBeAg+ individuals or when ALT/HBV DNA levels change significantly for patients not on antiviral therapy |
| HBsAg | Quantitative HBsAg is not recommended for routine testing. In patients with inactive CHB, evaluate for loss of HBsAg every 12 months3 | Quantitative HBsAg levels every 12 months. If not possible, a qualitative test is the minimum requirement for patients not on antiviral therapy |
| ALT | Every 3–6 months (or more frequently if elevated during immune-tolerant phase) for patients not on therapy3,4 | Every 3–6 months for the first year following diagnosis, then every 6–12 months depending on disease phase for patients not on antiviral therapy |
| Fibrosis assessment | Liver elastography or biopsy for elevated ALT or HCC family history in all HBsAg-positive patients3,4,7 | Noninvasive assessment at diagnosis and further monitoring should be considered depending on clinical evaluations of disease phase and presence of comorbidities for patients not on antiviral therapy |
| AASLD (2016/2018/2025)3,4,7† | |
|---|---|
| HBV DNA | Every 3–6 months (or every 1–3 months if levels are 2,000–20,000 IU/mL during immune-tolerant phase) for patients not on therapy3,4 |
| HBeAg | Every 6–12 months for patients not on therapy3 |
| HBsAg | Quantitative HBsAg is not recommended for routine testing. In patients with inactive CHB, evaluate for loss of HBsAg every 12 months3 |
| ALT | Every 3–6 months (or more frequently if elevated during immune-tolerant phase) for patients not on therapy3,4 |
| Fibrosis assessment | Liver elastography or biopsy for elevated ALT or HCC family history in all HBsAg-positive patients3,4,7 |
| EASL (2025)2 | |
|---|---|
| HBV DNA | Every 3–6 months for the first year following diagnosis, then every 6–12 months depending on disease phase for patients not on antiviral therapy |
| HBeAg | Every 12 months in HBeAg+ individuals or when ALT/HBV DNA levels change significantly for patients not on antiviral therapy |
| HBsAg | Quantitative HBsAg levels every 12 months. If not possible, a qualitative test is the minimum requirement for patients not on antiviral therapy |
| ALT | Every 3–6 months for the first year following diagnosis, then every 6–12 months depending on disease phase for patients not on antiviral therapy |
| Fibrosis assessment | Noninvasive assessment at diagnosis and further monitoring should be considered depending on clinical evaluations of disease phase and presence of comorbidities for patients not on antiviral therapy |
Please refer to the full publications for comprehensive management recommendations and refer to appropriate prescribing information for any treatment-specific monitoring requirements.
Review AASLD Guidelines for additional considerations regarding coinfection screening, HCC surveillance, and special populations, including pregnant women and immunosuppressed individuals.
KNOW THE NUMBERS. Know the complete picture.
Routine testing of all CHB biomarkers, including quantitative and qualitative HBsAg, may provide a fuller picture of patients’ disease and better inform clinical decisions.8-10
- Quantitative and qualitative HBsAg, HBeAg, and HBV DNA tests are commercially available8
- *
APRI and FIB-4 are formulaic tools to help determine stage of fibrosis and assess risk for liver-related morbidity and mortality.11
- †AASLD guidance does not seek to dictate a “one-size-fits-all” approach for the management of CHB; clinical considerations may justify a course of action that differs from this guidance.
- AASLD=American Association for the Study of Liver Diseases; ALT=alanine aminotransferase; anti-HBe=anti–hepatitis B e-antigen; APRI=aspartate aminotransferase to platelet ration index; AST=aspartate aminotransferase; DNA=deoxyribonucleic acid; EASL=European Association for the Study of the Liver; FIB-4=fibrosis-4; HBeAg=hepatitis B e-antigen; HBV=hepatitis B virus; HCC=hepatocellular carcinoma; HBsAg=hepatitis B surface antigen; MRI=magnetic resonance imaging; qHBsAg=quantitative hepatitis B surface antigen.
Learn about HBsAg as a biomarker
References
Coffin CS, et al. Can Liver J. 2018;1(4):156-217.
European Association for the Study of the Liver. J Hepatol. 2025;83(2):502-583.
Terrault NA, et al. Hepatology. 2018;67(4):1560-1599.
Ghany MG, et al. Hepatology. 2026;83(4):974-997.
Screening and testing for hepatitis B virus infection: CDC recommendations – United States, 2023. Centers for Disease Control and Prevention. March 10, 2023. Accessed April 5, 2026. https://www.cdc.gov/mmwr/volumes/72/rr/rr7201a1.htm
Yuen MF, et al. Nat Rev Dis Primers. 2018;4:18035.
Terrault NA, et al. Hepatology. 2016;63(1):261-283.
Ghany MG, Buti M, Lampertico P, Lee HM; 2022 AASLD-EASL HBV-HDV Treatment Endpoints Conference Faculty. J Hepatol. 2023;79(5):1254-1269.
Vachon A, Osiowy C. Viruses. 2021;13(6):951.
Additional hepatitis B blood tests. Hepatitis B Foundation. Accessed April 5, 2026. https://www.hepb.org/prevention-and-diagnosis/diagnosis/hepatitis-b-blood-tests/
Amernia B, et al. BMC Gastroenterol. 2021;21(1):453.