Assessment of chronic hepatitis B

All people who are hepatitis B surface antigen (HBsAg) positive should undergo an initial assessment to determine their stage of disease and requirement for treatment (see Indications for antiviral therapy). For information on clinical assessment of people with chronic hepatitis B, see the B Positive website.

Assessment of liver fibrosis is recommended as part of the initial assessment of chronic hepatitis BAustralian hepatitis B consensus statement 2022. Reassessment of liver fibrosis is recommended before starting antiviral therapy if significant time has passed since the initial assessment. Liver fibrosis is assessed using noninvasive methods such as transient elastography (eg FibroScan) or AST to Platelet Ratio Index (APRI). Occasionally liver biopsy may be indicated, for example in the setting of alternative pathology or inconclusive fibrosis assessment—seek specialist advice.

Given the dynamic natural history of hepatitis B infection, all people with chronic hepatitis B require regular review, at least every 12 months. Clinical review should include blood tests (alanine aminotransferase [ALT], hepatitis B virus [HBV] DNA and HBV serology) and assessing whether the patient meets criteria for treatment.

Note: All people with chronic hepatitis B require regular review, at least every 12 months.

Surveillance for hepatocellular carcinoma should be performed every 6 months in people with chronic hepatitis B at high risk of hepatocellular carcinoma—see Surveillance for hepatocellular carcinoma in patients with chronic hepatitis B.