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Hepatitis B Virus Biomarkers: In your view, what should be the complete list of biomarkers to monitor for those already diagnosed to have the Hepatitis B virus & how often should they be monitored?

Diagnosis &monitoring of Hepatitis B will entail specific biomarkers not necessarily related to functional blood chemistry. However, you can monitor biomarkers associated with liver health & function including albumin, ALT, AST, GGT, bili, VitD, etc.

Apart from the specific biomarkers for hepatitis B (HB) that measure the viral load, antibody, and antigen levels, some blood chemistry biomarkers are useful for assessing the health status of HB infection.

A comprehensive metabolic panel and CBC with differential are the basics that should be assessed at least annually.

Monitoring specific biomarkers every six months may be prudent particularly in someone with compromised nutrition status, excess oxidative stress, or someone who consistently consumes alcohol. For this you would want to round up the usual suspects:

  • Albumin, globulin
  • Bilirubin
  • Cholesterol
  • Enzymes: ALT, AST, GGT, alkaline phosphatase
  • Ferritin
  • Uric acid
  • Vitamin D 25(OH)D

Pay especially close attention to vitamin D status in HB and liver disease in general.

Frank vitamin D deficiency is common in hepatitis B infection. If liver damage is severe, you will likely see a positive correlation between vitamin D and albumin and platelets. Therefore, a low vitamin D will be accompanied by low albumin and low platelets. In severe disease, vitamin D may be inversely correlated with ALT and you’ll see a low vitamin D with an elevated ALT level (Hoan 2016). The AST:ALT ratio (De Ritis ratio) will also help to assess liver function (Woreta 2014)


Alatalo, Päivikki et al. “Biomarkers of liver status in heavy drinkers, moderate drinkers and abstainers.” Alcohol and alcoholism (Oxford, Oxfordshire) vol. 44,2 (2009): 199-203. doi:10.1093/alcalc/agn099

Chan, Henry Lik-Yuen et al. “Association of baseline vitamin D levels with clinical parameters and treatment outcomes in chronic hepatitis B.” Journal of hepatology vol. 63,5 (2015): 1086-92. doi:10.1016/j.jhep.2015.06.025

Farnik, Harald et al. “Low vitamin D serum concentration is associated with high levels of hepatitis B virus replication in chronically infected patients.” Hepatology (Baltimore, Md.) vol. 58,4 (2013): 1270-6. doi:10.1002/hep.26488

Hoan, Nghiem Xuan et al. “Association of vitamin D deficiency with hepatitis B virus-related liver diseases.” BMC infectious diseases vol. 16,1 507. 23 Sep. 2016, doi:10.1186/s12879-016-1836-0

Woreta TA, Alqahtani SA. Evaluation of abnormal liver tests. Med Clin North Am. 2014 Jan;98(1):1-16.

Zhao, Xin-Yan et al. “Vitamin D serum level is associated with Child-Pugh score and metabolic enzyme imbalances, but not viral load in chronic hepatitis B patients.” Medicine vol. 95,27 (2016): e3926. doi:10.1097/MD.0000000000003926