Diagnosis and Assessment
Assessment
����Initial evaluation of persons newly diagnosed with chronic HBV
infection should include history, physical examination and laboratory
testing as outlined in Table 3. (III)
����Give 2 doses of hepatitis A vaccine 6 to 18 months apart to all persons
with chronic hepatitis B not immune to hepatitis A. (II-3)
Table 3. Evaluation of Patients with Chronic HBV Infection
Initial evaluation
History and physical examination
Family history of liver disease, HCC
Laboratory tests to assess liver disease���complete blood counts with platelets, hepatic
panel, and prothrombin time
Tests for HBV replication ��� HBeAg/anti-HBe, HBV DNA
Tests to rule out viral coinfections ��� anti-HCV, anti-HDV (in persons from countries
where hepatitis D virus (HDV) infection is common and in those with history of
injection drug use), and anti-HIV in those at risk
Tests to screen for HCC ��� alpha fetoprotein (AFP) at baseline and, in high risk
patients, ultrasound
For patients who meet criteria for chronic hepatitis consider liver biopsy to grade and
stage liver disease
Suggested follow-up for patients not considered for treatment
(HBeAg(+), HBV DNA > 20,000 IU/mL and normal ALT)
ALT q 3-6 months, more often if ALT becomes elevated
If ALT levels are between 1-2 �� upper limit of normal (ULN), recheck ALT q 1-3 months;
consider liver biopsy if age > 40, ALT borderline or mildly elevated on serial tests.
Consider treatment if biopsy shows moderate/severe inflammation or significant fibrosis
If ALT > 2 �� ULN for 3-6 months and HBeAg(+), HBV DNA > 20,000 IU/ mL,
consider liver biopsy and treatment
Consider screening for HCC in relevant population
Inactive HBsAg carrier state
ALT q 3 months for 1 year. If persistently normal, ALT q 6-12 months
If ALT > 1-2 �� ULN, check serum HBV DNA level and exclude other causes of liver
disease. Consider liver biopsy if ALT borderline or mildly elevated on serial tests or if HBV
DNA persistently ��� 2,000 IU/mL. Consider treatment if biopsy shows moderate/severe
inflammation or significant fibrosis
Consider screening for HCC in relevant population
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