Treatment Figure 2. Management of Chronic HBV Infectiona
HBsAG-Positive HBeAG
Positive Negative
ALT < 1 × ULN q 6-12 mo HBeAg q 3-6 mo ALT ALT 1-2 × ULN
Consider biopsy if persistent or age > 40
q 6 mo HBeAg q 3 mo ALT Rx as needed ALT > 2 × ULN Rx as needed q 1-3 mo ALT & HBeAg Liver bx optional Treat if persistent
Immediate Rx if jaundice or decompensated
ALT, alanine aminotransferase; bx, biopsy; HBeAG, hepatitis B e antigen; HBsAG, hepatitis B surface antigen; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; IU/mL, international units per milliliter; mo, month; q, every; Rx, treat; ULN, upper limit of normal
a HCC surveillance if indicated. 14
then q 6-12 mo if ALT still < 1 × ULN
q 3 mo ALT × 3,
ALT < 1 × ULN; HBV DNA
< 2,000 IU/mL Liver biopsy optional Treat if persistent, 2,000-20,000 IU/mL
ALT 1-2 × ULN; HBV DNA
Consider biopsy if persistent
q 3 mo ALT & HBV DNA
ALT ≥ 2 × ULN; HBV DNA
≥ 20,000 IU/mL
