Large and middle hepatitis B surface antigen: the lower the better?

We read with great interest the article entitled 'Quantification of large and middle proteins of hepatitis B virus surface antigen (HBsAg) as a novel tool for the identification of inactive HBV carriers' by Pfefferkorn et al.1 Serum hepatitis B surface antigen (HBsAg) level has been shown to complement HBV DNA level in predicting clinical outcomes of patients with chronic HBV infection.2 3 In Asian patients, mostly genotype B and C infection, with a low viral load (HBV DNA  ≤2000 IU/mL), HBsAg level >1000 IU/mL indicates a higher risk of hepatitis flare, cirrhosis and hepatocellular carcinoma (HCC) development.2 3 In this paper, the authors confirmed that inactive carriers (IC) with HBV genotype A and D infection had a lower HBsAg level.1 Furthermore, they compared the composition of HBsAg between IC and patients with chronic hepatitis B and found that IC had lower...

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