Assay-Dependent Variability in HBV DNA Quantification: An Illustrative Case Report

Abstract Introduction Chronic hepatitis B virus (HBV) infection affected approximately 254 million people worldwide in 2022 and remains a major cause of liver-related morbidity and mortality according to the World Health Organization (WHO) Global Hepatitis Report 2024. Regular monitoring of serum alanine aminotransferase (ALT) levels and HBV DNA viral load is essential in patients who do not meet criteria for antiviral therapy, as it helps assess disease activity and guide future treatment decisions. Case Description A 29-year-old female, six months postpartum, with chronic HBV infection, presented for routine follow-up. Serial monitoring showed fluctuating HBV DNA levels despite normal liver function tests. To confirm this trend, HBV viral load testing was performed on the same blood sample using two different platforms: a semi-automated assay and a fully automated assay. The results showed a discrepancy between the two methods. Conclusion Our case highlights the potential importance of standardised laboratory methods and consistent testing platforms for reliable interpretation of HBV viral load during long-term monitoring. It also supports findings from existing literature regarding semi-automated and automated assay performance.