Treatment
HBeAg-Positive Chronic Hepatitis B ALT > 2 times ULN or moderate/severe hepatitis on biopsy, and HBV DNA > 20,000 IU/mL. Consider treating these patients. (I)
ÎDelay treatment for 3-6 months in persons with compensated liver disease to determine if spontaneous HBeAg seroconversion occurs. (II-2)
ÎPromptly treat patients with icteric ALT flares. (III)
ÎInitiate treatment with any of the 7 approved antiviral medications, but pegylated interferon-alpha (pegIFN-α), tenofovir or entecavir are preferred. (I)
ALT persistently normal or minimally elevated (< 2 times normal). These patients generally should not be treated. (I)
ÎConsider liver biopsy in patients with fluctuating or minimally elevated ALT levels, especially in those > 40 years of age. (II-3)
ÎInitiate treatment if there is moderate or severe necroinflammation or significant fibrosis on liver biopsy. (I)
Children with elevated ALT > 2 times normal.
ÎConsider treating these patients if ALT levels remain at this level for ≥ 6 months. (I)
ÎTreatment may be initiated with interferon-alpha (IFN-α) or lamivudine. (I) HBeAg-Negative Chronic Hepatitis B
ÎConsider for treatment patients with serum HBV DNA > 20,000 IU/mL and ALT > 2 times normal. (I)
ÎConsider liver biopsy for HBeAg-negative patients with lower HBV DNA levels (2,000-20,000 IU/mL) and borderline normal or minimally elevated ALT levels. (II-2)
ÎInitiate treatment if there is moderate/severe inflammation or significant fibrosis on biopsy. (I)
ÎInitiate treatment with any of the 7 approved antiviral medications, but
pegIFN-α, tenofovir or entecavir are preferred in view of the need for long-term treatment. (I for pegIFN-α, tenofovir, or entecavir and II-1 for IFN-α, adefovir, telbivudine and lamivudine).
Patients who failed to respond to prior IFN-α (standard or pegylated) therapy
ÎConsider retreatment with nucleoside analogues (NA) if they fulfill the criteria listed above. (I)
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