Table 4.
Treatment guidelines for chronic hepatitis B
| HBe Ag | HBV DNAa | ALTb | AASLD treatment guidelinesd | US hepatologists treatment algorithmd |
|---|---|---|---|---|
| + | <20,000 | Normal | Observe. Monitor ALT/HBeAg q6-12 monthse | Observe. Monitor ALT/HBeAg q6-12 monthse |
| + | ≥20,000 | Normalc | Observe. Monitor ALT/HBeAg q6-12 monthse | Consider biopsy, treatment if age>40 or ALT >ULN |
| + | ≥20,000 | 1–2× ULNc | Consider biopsy, treatment if age>40 and ALT persistently high | Treatf |
| + | ≥20,000 | ≥2× ULN | Treatf | Treatf |
| − | <2,000 | Normal | Observe. Monitor ALT/HBVDNA q6–12 monthse | Observe. Monitor ALT/HBVDNA q6–12 monthse |
| − | 2,000–20,000 | Normalc | Observe. Monitor ALT/HBVDNA q6–12 monthse | Consider biopsy; treat if disease present. Or monitor ALT for increase |
| − | 2,000–20,000 | 1–2× ULNc | Monitor ALT/HBVDNA q3mon. Consider Biopsy | Treatf |
| − | ≥20,000 | ≥2× ULN | Treatf | Treatf |
| +/− | <2,000 | Cirrhosis compensated | Consider treatment especially if ALT elevated. ADV or ETV are preferred agents | |
| +/− | ≥2,000 | Cirrhosis compensated | Treat. Combination therapy preferred (LAM + ADV, or LAM + ETV, or ADV +ETV) | |
| +/− | Any | Cirrhosis decompensated | Refer for transplant and treat with ADV + LAM, or ADV + ETV (combination therapy) | |
aValues shown in IU/mL (1 IU/mL is equivalent to approximately 5.6 copies/mL)
bThe upper limit of normal (ULN) for serum ALT concentrations for men and women are 30 IU/L and 19 IU/L, respectively
cDifferences in Recommendations from AASLD and US Hepatologists’ Guidelines
dLiver biopsy is strongly recommended before initiating treatment
eOn initial diagnosis, every 3 months for 1 year to ensure stability
fPegIFNα-2a, ETV, ADV are preferred over LAM because of high risk for resistance with lamivudine treatment. Choose antiviral if HBV DNA high or Genotype D. Choose PegIFNα-2a if Genotype A. Pretreatment genotype testing is not a standard recommendation at this time, but may be useful in patients with high-level viremia and significant liver disease, to help determine the most appropriate agent
ADV Adefovir, ETV Entecavir, LAM Lamivudine, IFN Interferon