HBeAg-Positive Patients
ÎPerform ALT test at 3-6 month intervals for HBeAg-positive patients with persistently normal ALT. When ALT levels become elevated, test more often for ALT along with HBV DNA. Check HBeAg status every 6-12 months. (III)
ÎConsider for liver biopsy patients who remain HBeAg positive with HBV DNA levels > 20,000 IU/mL after a 3-6 month period of elevated ALT levels between 1-2 × ULN, or who remain HBeAg positive with HBV DNA levels > 20,000 IU/mL and are > 40 years old.
• Consider treatment if biopsy shows moderate/severe inflammation or significant fibrosis. (III)
ÎConsider for treatment patients who remain HBeAg positive with HBV DNA levels > 20,000 IU/mL after a 3-6 month period of elevated ALT levels 2 × ULN. (III)
HBeAg-Negative Patients
ÎHBeAg-negative patients with normal ALT and HBV DNA < 2,000 IU/mL should be tested for ALT every 3 months during the first year to verify that they are truly in the "inactive carrier state" and then every 6-12 months. (III)
ÎPerform tests for HBV DNA and initiate more frequent monitoring if ALT or AST increases above the normal limit. (III)
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