Compensated cirrhosis
����Consider treatment for patients with ALT > 2 times normal and for
patients with normal or minimally elevated ALT if serum HBV DNA
levels are high (> 2,000 IU/mL). (II-2)
����Patients with compensated cirrhosis are best treated with NAs
because of the risk of hepatic decompensation associated with
IFN- �� ���related flares of hepatitis. In view of the need for long-term
therapy, tenofovir or entecavir is preferred. (II-3)
Decompensated cirrhosis
����Treatment should be promptly initiated with an NA that can produce
rapid viral suppression with low risk of drug resistance. (II-1)
������ Lamivudine or telbivudine may be used as initial treatment in combination with
adefovir or tenofovir to reduce the risk of drug resistance. (II-2)
������ Entecavir or tenofovir alone would be an appropriate treatment in this setting, but
clinical data documenting their safety and efficacy in patients with decompensated
cirrhosis are lacking. (III)
������ Treatment should be coordinated with a transplant center. (III)
������ IFN-��/pegIFN-�� should NOT be used in patients with decompensated ���
cirrhosis. (II-3)
Inactive HBsAg carrier state
����Antiviral treatment is NOT indicated, but these patients should be
monitored (see Figure 2). (II-2)
Dose Regimens
IFN-�� and pegIFN-�� are administered as subcutaneous injections
����The recommended dose of standard IFN- �� for adults is 5 MU daily or
10 MU thrice weekly. The recommended dose of pegIFN- ��2a is 180 mcg
weekly. (I)
����The recommended IFN- �� dose for children is 6 MU/m2 thrice weekly
with a maximum of 10 MU. (I)
Note: PegIFN-�� has not been approved for treatment of chronic hepatitis B in children.
��The recommended treatment duration for HBeAg-positive chronic
��
hepatitis B is 16 weeks for standard IFN-�� and 48 weeks for pegIFN-��. (I)
����The recommended treatment duration for HBeAg-negative chronic
hepatitis B is 48 weeks for both standard and pegIFN- �� . (II-3)
Nucleoside analogues are administered orally
����The recommended lamivudine dose for children is 3 mg/kg/d with a
maximum of 100 mg/d. (I)
����The recommended dose of lamivudine for persons coinfected with HIV
is 150 mg twice daily. Lamivudine should be used only in combination
with other antiretroviral medications. (I)
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