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Viral Hepatitis and Liver Disease

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When to treat chronic HBV

for Health Care Providers

When to Treat Chronic HBV - Hepatitis B

People living with HBsAG+ should begin treatment with antivirals based on the following.

Cirrhosis

  • With low level virema (less than 2,000 IU/ml)
  • Regardless of eAg and ALT

Decompensated cirrhosis

  • Regardless of HBV DNA, eAg, and ALT

Pregnant

  • If HBV DNA is greater than 2,000 IU/ml
  • Regardless of eAg and ALT

HBeAg negative

  • Immunoactive equals ALT greater than 2x ULN or significant histologic disease
  • HBV DNA is greater than 2,000

HBeAg positive

  • Immunoactive equals ALT greater than 2x ULN or significant histologic disease
  • HBV DNA is greater than 20,000

Only treat normal ALT if

  • Adult over 40 years old with an HBV DNA greater than 1 million IU/mL
  • Cirrhosis

Other factors to consider

  • Family history of hepatocellular carcinoma
  • Family history of cirrhosis
  • Older age (over 40 years old)
  • Extrahepatic manifestations of HBV

Prophylaxis against HBV reactivation

  • During treatment with immunosuppressive medication
  • During treatment with HCV direct-acting antiviral therapy