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We read with interest the recent article by Hui et al, who characterised quantitative hepatitis B surface antigen (qHBsAg) profiles, described longitudinal qHBsAg trajectories and identified factors associated with HBsAg seroclearance in a large cohort of patients with chronic hepatitis B (CHB).1 The qHBsAg, as a key marker of chronic HBV infection, is closely associated with treatment response and long-term prognosis.2–4 Hui et al reported that over 40% of patients with CHB had serum qHBsAg levels >1000 IU/mL,1 which was associated with a low likelihood of achieving HBsAg seroclearance with current antivirals and with suboptimal responses to novel antivirals.1 5–7 Moreover, the alanine aminotransferase (ALT) to qHBsAg ratio has been proposed as a novel predictor of both HBsAg seroclearance and qHBsAg trajectories, with patients having an ALT/qHBsAg ratio ≥0.27 demonstrating a significantly higher likelihood of achieving HBsAg seroclearance regardless of antiviral treatment.1 However, this study is limited by single-centre design and the relatively older age of included patients (mean age 48 years). Using a large, real-world, multicentre cohort of younger patients with CHB, we assessed the prevalence and clinical characteristics of patients across different qHBsAg levels and ALT/qHBsAg ratios. Moreover, we evaluated the association between ALT/qHBsAg ratios and HBsAg seroclearance in both treated and untreated patients.