Treatment of Chronic Hepatitis B
Treatment indicated in these cases of chronic hepatitis B:
1- Patients without Cirrhosis with persistently Elevated ALT level (Men ≥ 70 U/L, Women ≥ 50 U/L)
And
- HBeAg positive with HBV DNA level ≥ 20,000 IU/mL
- HBeAg negative with HBV DNA level ≥ 2,000 IU/mL
2- Patients with Significant Fibrosis (F2-F3) with persistently Elevated ALT level (Men > 35 U/L, women > 25 U/L)
And
- HBeAg positive with HBV DNA level ≥ 20,000 IU/mL
- HBeAg negative with HBV DNA level ≥ 2,000 IU/mL
3- Patients with Cirrhosis (compensated or decompensated) Regardless of ALT, HBV DNA levels and HBeAg status
Prophylactic antiviral therapy is recommended for:
1- HBsAg positive patients (regardless of baseline ALT and HBV DNA levels or HBeAg status) receiving immunosuppressive/cancer therapy or hepatitis C antiviral therapy.
2- To reduce the risk of perinatal transmission of hepatitis B in HBsAg pregnant women with very high antenatal HBV DNA level (>200,000 IU/mL): TNF from 28-32 weeks of pregnancy until birth.
Due to high potency and lower risk or reactivation, Entecavir and tenofovir have largely replaced other oral antivirals.
Interferon is seldom used these days due to side effects (including flu-like symptoms, hair loss, leukopenia, psychiatric effects) and is contraindicated in elderly people, major depression and decompensated liver cirrhosis.
This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your local emergency services. Please refer to your doctor for medical advice.