What are the key laboratory tests to monitor in patients with chronic Hepatitis B infection?

Key laboratory tests to monitor in patients with chronic hepatitis B infection include:

• Hepatitis B virus (HBV) DNA levels to assess viral replication and response to treatment; typically monitored before treatment initiation, at 12, 24, and 48 weeks after starting antiviral therapy, and then every 6 months during treatment ¹.
• Hepatitis B surface antigen (HBsAg) quantitative levels to evaluate infection status and treatment response, monitored alongside HBV DNA and HBeAg status ¹.
• Hepatitis B e antigen (HBeAg) and anti-HBe antibodies to determine viral replication phase and seroconversion status, monitored before treatment and periodically during follow-up ¹.
• Alanine aminotransferase (ALT) levels to assess liver inflammation, monitored every 24 weeks in immune-tolerant patients and every 12 weeks if ALT rises; in inactive carriers, ALT and HBV DNA are monitored annually ¹.
• Liver function tests (including bilirubin and albumin) to evaluate liver synthetic function, especially before and during antiviral treatment ¹.
• Full blood count to detect treatment-related adverse effects, monitored before and periodically during antiviral therapy ¹.
• Renal function tests (urea, electrolytes, urine protein/creatinine ratio) and phosphate levels particularly in patients on tenofovir disoproxil, monitored before treatment, 4 weeks after starting, and then every 3 months ¹.
• Blood clotting studies in patients with decompensated liver disease before and during treatment ¹.
• Alpha-fetoprotein (AFP) and hepatic ultrasound every 6 months for hepatocellular carcinoma surveillance in patients with significant fibrosis or cirrhosis ¹.