Treatment
Hepatitis B Carriers Who Require Immunosuppressive or Cytotoxic Therapy
ÎPerform HBsAg and anti-HBc testing in patients who are at high risk of HBV infection (see Table 2) prior to initiating chemotherapy or immunosuppressive therapy. (II-3)
ÎPrescribe prophylactic antiviral therapy for HBV carriers at the onset of cancer chemotherapy or a finite course of immunosuppressive therapy.
• Patients with baseline HBV DNA < 2,000 IU/mL should continue treatment for 6 months after completion of chemotherapy or immunosuppressive therapy. (III)
• Patients with high baseline HBV DNA (> 2,000 IU/mL) should continue treatment until they reach treatment endpoints as in immunocompetent patients. (III)
• Use lamivudine or telbivudine if the anticipated duration of treatment is short (≤ 12 months) and baseline serum HBV DNA is not detectable. (I for lamivudine; III for telbivudine)
Acute Symptomatic Hepatitis B
ÎTreatment is indicated only for patients with fulminant hepatitis B and those with protracted, severe acute hepatitis B. (III)
ÎUse lamivudine or telbivudine when the anticipated duration of treatment is short. Otherwise, entecavir is preferred. (II-3)
• IFN-α is contraindicated. (III) Monitoring Chronic HBV Infection (Figure 2)
• Continue treatment until HBsAg clearance is confirmed or indefinitely in those who undergo liver transplantation. (II-1)
ÎHBeAg-positive and HBeAg-negative patients who meet criteria for chronic hepatitis B (see Key Points) should be evaluated for treatment. (I)
• Tenofovir or entecavir is preferred if longer duration of treatment is anticipated. (III) • IFN-α should be avoided in view of the bone marrow suppressive effect. (II-3)
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