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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
  1. *HBV DNA > 105. Abbreviations: HBeAg: hepatitis B e antigen; HBV: hepatitis B virus; ALT: alanine aminotransferase; ULN: upper limit of normal; IFN-α: interferon alfa; LAM: lamivudine; ADV: adefovir; PCR: polymerase chain reaction. Source: Lok AS, McMahon BJ. Chronic hepatitis B: update of recommendations. Hepatology 2004;39:857-61.