Table 8. Recommendations for Treatment of Chronic
Hepatitis B (continued)
HBeAg
���
HBV DNA
(PCR)
ALT
Treatment Strategy
> 20,000 ���
IU/mLa
>2��
ULN
IFN-�� /pegIFN-��, LAM, ADV, ETV, TDF or
LdT may be used as initial therapy.
LAM and LdT NOT preferred due to high rate
of drug resistance.
ADV NOT preferred due to weak antiviral
activity and high risk of resistance after 1st year.
End-point of treatment ��� not defined.
Duration of therapy:
������ IFN-��/pegIFN-��: 1 year
������ LAM/ADV/ETV/LdT/TDF: > 1 year
IFN-�� non-responders / contraindications to
IFN-�� ��� TDF/ETV.
���
> 2,000 IU/mL 1-2 ��
ULN
Consider liver biopsy and treat if liver biopsy
shows moderate/severe necroin���ammation or
signi���cant ���brosis.
���
��� 2,000 IU/mL ��� ULN
Observe; treat if HBV DNA or ALT ���.
+/���
Detectable
Cirrhosis
Compensated:
������ HBV DNA > 2,000 IU/mL: ���
Treat: LAM/ADV/ETV/LdT/TDF
may be used as initial therapy.
������ LAM and LdT NOT preferred due
to high rate of drug resistance; ADV
NOT preferred due to weak antiviral
activity and high risk of resistance
after 1st year.
������ HBV DNA < 2,000 IU/mL: Consider
treatment if ALT elevated.
Decompensated:
������ Coordinate treatment with transplant
center. LAM (or LdT) + ADV, TDF or
ETV preferred.
������ Refer for liver transplant.
+/���
Undetectable
Cirrhosis
Compensated: Observe.
Decompensated: Refer for liver transplant.
a
Treatment may be considered in patients with HBV DNA 2,000-20,000 IU/mL, particularly if
they are older or have cirrhosis. Although several studies including the REVEAL study showed a
correlation between serum HBV DNA and clinical outcomes such as HCC, only patients with one
or both samples at baseline and last follow-up with serum HBV DNA > 100,000 copies/mL ���
(> 20,000 IU/mL) had significantly increased risk of HCC. (Chen CJ, et al. JAMA. 2006;295:65-73).
17
