Hepatitis B Treatment Guidelines

(AASLD)
Work-up for HbsAg +ve Patient
CBC, LFT, INR, HBeAg and anti-HBe
PCR Quantitative
USG abdomen
If required anti-HCV, HIV, Hep A, Hep D, Biopsy if needed

Treatment Recommendation
1. Immune Tolerant Phase (ALT normal, PCR elevated, HBeAg
+ve)
No treatment required Monitor ALT 6 monthly
Treat if Age > 40, PCR > 1 000 000, Biopsy show
fibrosis
2. Immune Active Phase (ALT raised, PCR elevated, HBeAg +ve)
Entecavir or Tenofovir or Peg-IFN
3. Inactive Chronic Hepatitis B Phase (ALT normal, PCR <2000,
HBeAg ve)
No treatment required
4. Immune re-activation phase (ALT raised, PCR elevated,
HBeAg ve)
Indefinite treatment

Duration of treatment
HBeAg seroconverted to anti-HBe (Non Cirrhotic Patient)
Consolidate treatment for at least 1 year
(Normal ALT and Undetectable PCR persistently for 1 year)
HBeAg seroconverted to anti-HBe (Cirrhotic Patient)
Lifelong treatment
HBeAg +ve with decompensated Cirrhosis
Indefinite treatment
Persistent low elevated PCR
Continue monotherapy or add 2nd drug
Pregnancy
Treat only if PCR > 200 000 & HBeAg +ve
Tenofovir drug of choice