Chronic Hepatitis B - Diagnosis and Management Algorithm

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Chronic Hepatitis B - Diagnosis and Management Algorithm

• Who to treat: Essentially treat the pts with chronic HBV infections who have serologic evidence of hepatitis and viremia or have cirrhosis.

• Keep in mind that patients transition between the above phases of chronic HBV and thus periodic monitoring is warranted.

• Monitor: CBC. CMP. Quant HBV DNA. Hbe-Ag. anti-Hbe, HIV, HCV. HAV immunity; Liver fibrosis (transient elastographv, liver Bx)

• Tx option: first line Entacavir, tenofovir vs interferons, Lamivudine

• Tx goal: Reduce liver inflammation (decr ALT). seroconversion of HBsAg or HBeAG.

• Seroconversion is very difficult and thus lifelong tx is usually warranted.

• Liver is the reservoir of HBV and thus even if viremia is absent the risk of reactivation with immunosuppressive therapy is high.

If your interested in learning more-Tang LSY, Covert E, Wilson E, Kottilil S. Chronic Hepatitis B Infection: A Review. JAMA. 2018;319(17):1802–1813. doi:10.1001/jama.2018.3795

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