Hepatitis B - Treatment Indications
Treatment not ...
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Description

Hepatitis B - Treatment Indications

Treatment not indicated:

 • Immune tolerant state - HBe-Ag detectable, high HBV DNA (>10^6 IU/mL), normal ALT, age < 30-40 years 

 • Low replicative state - HBe-Ag undetectable, low HBV DNA (<2000 IU/mL), normal ALT

Treatment possibly indicated:

 • HBe-Ag detectable, high HBV DNA (>10^6 IU/mL), normal ALT, and age > 30-40 years

 • Presence of CP or PC mutation

 • HBV genotype C

 • Age > 30-40 years

 • Moderate immunosuppression*

 • Extrahepatic manifestations of HBV

 • HIV/HCV co-infection

 • Family history of cirrhosis

 • Personal or family history of HCC

Treatment Indicated:

 • HBV DNA > 2000 IU/mL and ALT > 2xULN

 • HBV DNA > 2000 IU/mL and ALT > ULN, with moderate necroinflammatory activity and/or fibrosis

 • Cirrhosis

 • Pregnancy with HBV DNA > 200,000 IU/mL (begin for vertical transmission prophylaxis at 28-32 weeks gestation)

 • Use of B-cell depleting agents or marked immunosuppression

 • Acute HBV infection with severe liver injury (INR > 2, bilirubin > 3 mg/dL) or acute liver failure



#HepatitisB #HepBV #HBV #Treatment #Indications #management #hepatology
Contributed by

Dr. Michael Chew
@mchew85
GrepMed Gastroenterology-Hepatology Editor, Academic Hospitalist UC Davis Medical Center Internal Medicine, Yale Gastroenterology Fellow '22
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