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. Author manuscript; available in PMC: 2014 Oct 1.
Published in final edited form as: Nat Rev Gastroenterol Hepatol. 2013 Nov 19;11(4):209–219. doi: 10.1038/nrgastro.2013.216

Figure 3.

Figure 3

A management algorithm for patients with HBV infection prior to starting immunosuppressive therapy. Algorithm based on scientific literature when available and opinions of the authors when literature lacked data. *Risk: stratify patients by risk of reactivation (see Table 2). ‡Prophylactic antiviral therapy: patients at high or moderate risk of reactivation (see Table 2) should start antiviral therapy and be assessed for virologic response through HBV DNA testing every 3 months. §Monitoring: check HBV DNA and ALT every 3 months; check HBsAg in patients who were HBsAg−/anti-HBc+ before immunosuppressive therapy. II Pre-emptive antiviral therapy: initiate antiviral therapy if ALT levels are elevated, HBV DNA levels are elevated, or appearance of HBV DNA or HBsAg in patients who had undetectable HBV DNA or HBsAg before immunosuppressive therapy, respectively. Abbreviations: +, positive; −, negative; anti-HBc, anti-hepatitis B core antibody IgG; HBsAg, hepatitis B surface antigen.