Treatment
Table 8. Recommendations for Treatment of Chronic Hepatitis B
HBeAg +
HBV DNA (PCR)
> 20,000 IU/mL
ALT Treatment Strategy
≤ 2 × ULN
Low efficacy with current treatment.
Observe; consider treatment when ALT becomes elevated.
Consider biopsy in persons > 40 years, ALT persistently high normal (2 × ULN) or with family history of HCC.
Consider treatment if HBV DNA > 20,000 IU/mL and biopsy shows moderate/severe inflammation or significant fibrosis.
+
> 20,000 IU/mL
> 2 × ULN
Observe for 3-6 months and treat if no spontaneous HBeAg loss.
Consider liver biopsy prior to treatment if compensated.
Immediate treatment if icteric or clinical decompensation.
IFN-α/pegIFN-α , LAM, ADV, ETV, TDF or LdT may be used as initial therapy.
ADV NOT preferred due to weak antiviral activity and high rate of resistance after 1st year.
LAM and LdT NOT preferred due to high rate of drug resistance.
End-point of treatment – Seroconversion from HBeAg to anti-HBe.
Duration of therapy:
• IFN-α: 16 weeks • PegIFN-α: 48 weeks • LAM/ADV/ETV/LdT/TDF: ≥ 1 year, continue for at least 6 months after HBeAg seroconversion
IFN-α non-responders / contraindications to IFN-α → TDF/ETV.
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