Duration of Nucleoside Analogue Treatment
HBeAg-positive chronic hepatitis B
����Continue treatment until the patient has achieved HBeAg
seroconversion and undetectable serum HBV DNA and completed at
least 6 months of additional treatment after appearance of anti-HBe. (I)
������ Close monitoring for relapse is needed after withdrawal of treatment. (I)
HBeAg-negative chronic hepatitis B
����Continued treatment until the patient achieves HBsAg clearance. (I)
Compensated cirrhosis
����These patients should receive long-term treatment. However,
treatment may be stopped in HBeAg-positive patients if they have
confirmed HBeAg seroconversion and have completed at least 6
months of consolidation therapy and, in HBeAg-negative patients, if
they have confirmed HBsAg clearance. (II-3)
������ Close monitoring for viral relapse and hepatitis flare is mandatory if treatment is
stopped. (II-3)
Decompensated cirrhosis and recurrent hepatitis B post���liver
transplantation
����Life-long treatment is recommended. (II-3)
HBV/HIV Coinfection
����Treat patients who meet criteria for chronic hepatitis B. (III)
����Consider biopsy in patients with fluctuating or mildly elevated ALT
(1-2 �� normal). (II-3)
����Treat patients who are not on highly active antiretroviral therapy
(HAART) and are not anticipated to require HAART in the near future
with an antiviral therapy that does not target HIV, such as pegIFN- �� or
adefovir. Although telbivudine does not target HIV, it should NOT be
used in this circumstance. (II-3)
����Treat patients in whom treatment for both HBV and HIV is planned
with therapies that are effective against both viruses: lamivudine plus
tenofovir or emtricitabine plus tenofovir are preferred. (II-3)
����Treat patients who are already on effective HAART that does not
include a drug active against HBV with pegIFN- �� or adefovir. (II-3)
����In patients with lamivudine resistance, add tenofovir. (III)
����When HAART regimens are altered, do NOT discontinue drugs
that are effective against HBV without substituting another drug
that has activity against HBV, unless the patient has achieved
HBeAg seroconversion and has completed an adequate course of
consolidation treatment. (II-3)
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