Treatment
HBeAg-Positive Chronic Hepatitis B
ALT > 2 times ULN or moderate/severe hepatitis on biopsy, and
HBV DNA > 20,000 IU/mL. Consider treating these patients. (I)
��Delay treatment for 3-6 months in persons with compensated liver
��
disease to determine if spontaneous HBeAg seroconversion occurs. (II-2)
����Promptly treat patients with icteric ALT flares. (III)
����Initiate treatment with any of the 7 approved antiviral medications,
but pegylated interferon-alpha (pegIFN- ��), tenofovir or entecavir are
preferred. (I)
ALT persistently normal or minimally elevated (< 2 times normal).
These patients generally should not be treated. (I)
����Consider liver biopsy in patients with fluctuating or minimally elevated
ALT levels, especially in those > 40 years of age. (II-3)
����Initiate treatment if there is moderate or severe necroinflammation or
significant fibrosis on liver biopsy. (I)
Children with elevated ALT > 2 times normal.
����Consider treating these patients if ALT levels remain at this level for
��� 6 months. (I)
��Treatment may be initiated with interferon-alpha (IFN-��) or lamivudine. (I)
��
HBeAg-Negative Chronic Hepatitis B
����Consider for treatment patients with serum HBV DNA > 20,000 IU/mL
and ALT > 2 times normal. (I)
����Consider liver biopsy for HBeAg-negative patients with lower HBV
DNA levels (2,000-20,000 IU/mL) and borderline normal or minimally
elevated ALT levels. (II-2)
����Initiate treatment if there is moderate/severe inflammation or
significant fibrosis on biopsy. (I)
����Initiate treatment with any of the 7 approved antiviral medications, but
pegIFN- �� , tenofovir or entecavir are preferred in view of the need for
long-term treatment. (I for pegIFN- �� , tenofovir, or entecavir and II-1 for
IFN- �� , adefovir, telbivudine and lamivudine).
Patients who failed to respond to prior IFN-�� (standard or
pegylated) therapy
����Consider retreatment with nucleoside analogues (NA) if they fulfill the
criteria listed above. (I)
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