Diagnosis of
chronic hepatitis B virus (HBV)
infection, initial staging of
infection and monitoring of treated and untreated patients are mainly based on clinical,
biological and imaging criteria allowing a complete non-invasive management for the majority of patients. Along to the conventional virological tools, rapid diagnostic tests and blotting paper tests for HBV
DNA are validated alternatives. After diagnosis, the initial work-up should include HIV, HCV and HDV serologies,
HBeAg status, and
HBsAg and HBV
DNA quantification. Assessment of severity (
inflammation and
fibrosis) is based on ALT serum levels and non-invasive evaluation of
liver fibrosis by elastography or blood tests, which must be interpreted cautiously using specific cut-offs and taking into account ALT levels. Taken together, these parameters allow disease classification and treatment decision. Decision of
hepatocellular carcinoma screening by ultra-sound every six months may be difficult in non-cirrhotic patients and the use of risk-scores such as PAGE-B is encouraged. Chronic HBV
infection often has a dynamic and often unpredictable profile and regular monitoring is mandatory. In untreated patients, regular (3-12 months) follow-up should include ALT and HBV
DNA serum levels. Periodical
HBsAg quantification and non-invasive evaluation of
liver fibrosis may refine disease outcome and prognosis. In treated patients, checking efficacy is mainly based on HBV
DNA negativity. In patients with advanced
fibrosis, evolution of liver stiffness can be useful for
portal hypertension evaluation, but its improvement should not be considered to stop
hepatocellular carcinoma screening. Finally, new parameters (HBV
RNA, HBcrAg) are promising but their use is still restricted for research.