Treatment
Figure 2. Management of Chronic HBV Infectiona
HBsAG-Positive
HBeAG
Positive
Negative
ALT < 1 �� ULN
ALT ��� 2 �� ULN;
HBV DNA ���
��� 20,000 IU/mL
q 3-6 mo ALT
q 6-12 mo HBeAg
ALT 1-2 �� ULN
Treat if persistent,
Liver biopsy optional
q 3 mo ALT
q 6 mo HBeAg
Consider biopsy if
persistent or ���
age > 40
Rx as needed
ALT 1-2 �� ULN;
HBV DNA ���
2,000-20,000 IU/mL
q 3 mo ALT &
HBV DNA
Consider biopsy if
persistent
ALT > 2 �� ULN
Rx as needed
q 1-3 mo ALT & HBeAg
Liver bx optional
ALT < 1 �� ULN;
HBV DNA ���
< 2,000 IU/mL
Treat if persistent
Immediate Rx if jaundice
or decompensated
q 3 mo ALT �� 3,
then q 6-12 mo if ALT
still < 1 �� ULN
a
HCC surveillance if indicated.
ALT, alanine aminotransferase; bx, biopsy; HBeAG, hepatitis B e antigen; HBsAG, hepatitis B
surface antigen; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; IU/mL, international
units per milliliter; mo, month; q, every; Rx, treat; ULN, upper limit of normal
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