Compensated cirrhosis
ÎConsider 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)
ÎPatients with compensated cirrhosis are best treated with NAs because of the risk of hepatic decompensation associated with
IFN-α–related flares of hepatitis. In view of the need for long-term therapy, tenofovir or entecavir is preferred. (II-3) Decompensated cirrhosis
ÎTreatment 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)
• Treatment should be coordinated with a transplant center. (III) • IFN-α/pegIFN-α should NOT be used in patients with decompensated cirrhosis. (II-3)
Inactive HBsAg carrier state
ÎAntiviral treatment is NOT indicated, but these patients should be monitored (see Figure 2). (II-2)
Dose Regimens IFN-α and pegIFN-α are administered as subcutaneous injections
ÎThe recommended dose of standard IFN-α for adults is 5 MU daily or 10 MU thrice weekly. The recommended dose of pegIFN-α2a is 180 mcg weekly. (I)
ÎThe recommended IFN-α dose for children is 6 MU/m2 thrice weekly
with a maximum of 10 MU. (I) Note: PegIFN-α has not been approved for treatment of chronic hepatitis B in children.
ÎThe recommended treatment duration for HBeAg-positive chronic hepatitis B is 16 weeks for standard IFN-α and 48 weeks for pegIFN-α. (I)
ÎThe recommended treatment duration for HBeAg-negative chronic hepatitis B is 48 weeks for both standard and pegIFN-α. (II-3)
Nucleoside analogues are administered orally
ÎThe recommended lamivudine dose for children is 3 mg/kg/d with a maximum of 100 mg/d. (I)
ÎThe 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)
• 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)
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