Diagnosis and Assessment Assessment
ÎInitial evaluation of persons newly diagnosed with chronic HBV infection should include history, physical examination and laboratory testing as outlined in Table 3. (III)
ÎGive 2 doses of hepatitis A vaccine 6 to 18 months apart to all persons with chronic hepatitis B not immune to hepatitis A. (II-3)
Table 3. Evaluation of Patients with Chronic HBV Infection Initial evaluation
History and physical examination Family history of liver disease, HCC
Laboratory tests to assess liver disease—complete blood counts with platelets, hepatic panel, and prothrombin time Tests for HBV replication — HBeAg/anti-HBe, HBV DNA
Tests to rule out viral coinfections — anti-HCV, anti-HDV (in persons from countries where hepatitis D virus (HDV) infection is common and in those with history of injection drug use), and anti-HIV in those at risk
Tests to screen for HCC — alpha fetoprotein (AFP) at baseline and, in high risk patients, ultrasound
For patients who meet criteria for chronic hepatitis consider liver biopsy to grade and stage liver disease
Suggested follow-up for patients not considered for treatment (HBeAg(+), HBV DNA > 20,000 IU/mL and normal ALT) ALT q 3-6 months, more often if ALT becomes elevated
If ALT levels are between 1-2 × upper limit of normal (ULN), recheck ALT q 1-3 months; consider liver biopsy if age > 40, ALT borderline or mildly elevated on serial tests. Consider treatment if biopsy shows moderate/severe inflammation or significant fibrosis
If ALT > 2 × ULN for 3-6 months and HBeAg(+), HBV DNA > 20,000 IU/ mL, consider liver biopsy and treatment
Consider screening for HCC in relevant population Inactive HBsAg carrier state
ALT q 3 months for 1 year. If persistently normal, ALT q 6-12 months
If ALT > 1-2 × ULN, check serum HBV DNA level and exclude other causes of liver disease. Consider liver biopsy if ALT borderline or mildly elevated on serial tests or if HBV DNA persistently ≥ 2,000 IU/mL. Consider treatment if biopsy shows moderate/severe inflammation or significant fibrosis
Consider screening for HCC in relevant population 4
