Phase-dependent interpretation of quantitative hepatitis B surface antigen and hepatocellular carcinoma risk in chronic hepatitis B infection

Table 2 Implementation barriers and proposed solutions for quantitative hepatitis b surface antigen-guided risk stratification

Barrier	Details	Proposed solution
Cost	$50-$100 per test	Targeted testing in higher-risk subgroups (age > 50, family history of HCC, ≥ F2 fibrosis)
Insurance coverage	Not covered in some regions	Advocate for coverage in high-risk subgroups (HBeAg-negative, low viremia)
Accessibility	Not available in low-resource settings where HBV burden is highest	Point-of-care qHBsAg tests in development; advocate for technology transfer[40]
Assay standardization	Different absolute values across platforms (Abbott, Roche, Siemens)	Use same platform for serial monitoring; cross-platform calibration studies needed
Clinician training	Unfamiliarity with phase-dependent interpretation	Educational materials and clinical decision aids
Turnaround time	Results may take days	Not suitable for same-day decisions; plan testing at routine visits
Genotype applicability	Cutoffs validated only for genotypes B and C	Prospective validation in non-Asian populations required before broad adoption[3,40]

HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma; HBeAg: Hepatitis B e antigen; qHBsAg: Quantitative hepatitis B surface antigen.