Table 2

Proposed functional HBV categorisation of patients based on screening test results

Screening test resultsRisk of progression during biological therapyManagement considerations
Never infectedHBcAb negative, HBsAg negative, HBsAb negativeNoneConsider HBV vaccination if at risk of acquiring HBV
HBV vaccinatedHBcAb negative, HBsAg negative, HBsAb positiveNoneN/A
Resolved HBV*HBcAb positive, HBsAg negative, HBsAb positiveImmunity suggestedObtain baseline HBV DNA
Low risk (but not zero)If positive: patient has chronic HBV
If negative: periodic monitoring of HBV-DNA levels and liver function tests during biological therapy
HBcAb positive, HBsAg negative, HBsAb negativeImmunity not clear
Low to moderate risk of progression
Chronic HBVHBsAg positive, (regardless of other results)HighIf biological therapy is not avoidable, then refer to GI or ID specialist for concurrent and appropriate anti-HBV therapy
Periodic monitoring of HBV-DNA levels and liver function tests during biological therapy
  • * Patients in this category may also rarely be HBsAb positive in isolation.

  • Patients with HBsAb positivity have probably cleared their virus, although there still exists a small risk of seroreversion and reactivation during immunosuppresssion.8

  • In the case of HBsAb negativity, this substantially increases the risk that a patient has not cleared their HBV infection. Some proportion of these patients have either occult viraemia (detectable serum HBV DNA) or can reactivate later during immunosuppression in which HBV DNA and/or surface antigen will become detectable.

  • HBcAb, hepatitis B core antibody; HBsAb, hepatitis B surface antibody; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus.