Table 1 AASLD Recommendations for Treatment of Chronic Hepatitis B
From: Natural history and treatment of hepatitis B virus and hepatitis C virus coinfection
HBeAg | HBV DNA | ALT | Treatment Strategy |
|---|---|---|---|
+ | + | ≤2 × ULN | Low efficacy with current treatment. Observe; consider treatment when ALT becomes elevated |
+ | + | >2 × ULN | IFN-α, LAM, or ADV may be used as initial therapy End point of treatment = seroconversion from HbeAg to anti-Hbe Duration of therapy: • IFN-α: 16 weeks • LAM: minimum 1 year, continue for 3–6 months after HbeAg seroconversion • ADV: minimum 1 year IFN-α nonresponders/contraindications to IFN-α → LAM or ADV LAM resistance → ADV |
- | + | >2 × ULN | IFN-α, LAM or ADV may be used as initial therapy, IFN-α or ADV is preferred End point of treatment = sustained normalization of ALT and undetectable HBV DNA by PCR assay Duration of therapy: • IFN-α: 1 year • LAM: > 1 year • ADV: > 1 year IFN-α nonresponders/contraindications to IFN-α → LAM or ADV LAM resistance → ADV |
- | - | ≤2 × ULN | No treatment required |
± | + | Cirrhosis | Compensated: LAM or ADV Decompensated: LAM (or ADV); Refer for liver transplant. IFN-α contraindicated. |
± | - | Cirrhosis | Compensated: Observe Decompensated: Refer for liver transplant |