AASLD Treatment Guidelines for Chronic Hepatitis B
| ALT | HBV DNA | Treatment? | Biopsy?a |
|---|
| HBeAg positive | <ULN | Any | No. If HBV DNA >20,000, monitor ALT and HBV DNA levels every 3–6 mo and HBeAg every 6–12 mo. | | | >ULN but <2× ULN | 2000–20,000 IU/mL | Treat if lab abnormalities persist for >6 mo.
Treat if ALT elevation persists and patient is older than 40 y or if there is at least F2 fibrosis or A3 inflammation. | Consider | | >20,000 | Treat if ALT elevation persists and patient is older than 40 y or if there is at least F2 fibrosis or A3 inflammation. | Consider | | >2× ULN | 2000–20,000 IU/mL | Treat if lab abnormalities persist for >6 mo.
Treat if ALT elevation persists and patient is older than 40 y or if there is at least F2 fibrosis or A3 inflammation. | Consider | | >20,000 | Treat | | | HBeAg negative | <ULN | >2000 IU/mL | No. Monitor ALT and HBV DNA every 3 mo for 1 y and then every 6 mo. | | | <2000 | No. Monitor ALT and HBV DNA levels every 3–6 mo and and HBsAg annually. | | | >ULN but <2× ULN | >2000 IU/mL | Treat if staging of liver disease is a least F2 fibrosis or A3 inflammation or age older than 40 y. | Consider | | <2000 | Treat if staging of liver disease is a least F2 fibrosis or A3 inflammation or age older than 40 y. | Consider | | >2× ULN | >2000 IU/mL | Treat | | | <2000 | Treat if staging of liver disease is a least F2 fibrosis or A3 inflammation or age older than 40 y. | Consider |
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AASLD, American Association for the Study of Liver Diseases; ALT, alanine aminotransferase; HBeAg, hepatitis B e antigen; HBV, hepatitis B virus; ULN, upper limit of normal (ULN for AASLD: 35 units/L for males, 25 units/L for females).
a Biopsy indicated for patients older than 40 years, ALT persistently 1−2× ULN, and family history of hepatocellular carcinoma. Alternative methods of noninvasive fibrosis testing may be used.