A combination of different diagnostic tools allows identification of inactive hepatitis B virus carriers at a single time point evaluation

Background & Aims Serial evaluation of hepatitis B virus ( HBV ) DNA and aminotransferase values is required for identification of inactive HBV carriers ( IC s). Recently, HBV surface antigen quantification ( qHBsA g) and liver stiffness measurement ( LSM ) have been proposed as diagnostic tools in chronic HBV infection. The aim of this study was to evaluate the efficacy of HBV DNA quantification, qHBsA g and LSM in diagnosing IC s at a single time point. Methods Fifty‐seven previously characterized IC s and 90 untreated HB sAg‐/anti‐ HB e‐positive patients [49 chronic hepatitis ( CH ), 41 cirrhosis] were enrolled. HBV DNA ≤2000 IU/mL, LSM ≤6.2 kPa and qHBsAg ≤1000 IU/mL were used as cut‐offs to evaluate sensitivity, specificity, positive predictive value ( PPV ), negative predictive value ( NPV ) and diagnostic accuracy (DA). Results Combined HBV DNA quantification and qHBsA g correctly identified 30/57 (52.6%) IC s showing 94% sensitivity, 96% specificity, 98% PPV , 87% NPV and 95% DA . HBV DNA coupled with LSM identified 40/57 (70.2%) IC s showing 97% sensitivity, 97% specificity, 98% PPV , 95% NPV and 97% DA . Combined LSM and qHBsA g identified 33/57 (57.9%) IC s showing 95% sensitivity, 78% specificity, 89% PPV , 89% NPV and 89% DA . The evaluation of the three parameters altogether allowed the identification of 23/57 (40.3%) IC s showing 100% specificity, 96% sensitivity, 100% PPV , 92% NPV and 97% DA . Similar results were obtained when either CH or cirrhotic patients were excluded from the analysis. Conclusions Combined evaluation of HBV DNA amount with LSM and/or qHBsA g is a highly reliable tool allowing the identification of a considerable number of HBV IC s at a single time point evaluation.