Chronic Hepatitis B Treatment Decision Tool For Adults
| Question | Answer |
|---|---|
| Is your patient HBeAg positive? | |
| Does your patient have cirrhosis or significant fibrosis (F2-F4)? | |
| What is your patient's ALT level? | |
| What is your patient's HBV DNA level? | |
| Recommendation | |
The result shows antiviral treatment is indicated at this time• Entecavir (ETV 0.5 mg/pill/day) or Tenofovir disoproxil fumarate (TDF 300mg/pill/day) or Tenofovir alafenamide fumarate (TAF 25mg/pill/day) are the recommended first line treatment because of their potency and low risk of developing drug resistance.• The medicines act by preventing the hepatitis B virus from replicating • Important to take the medicine daily to prevent the development of drug resistance. Patients who had taken lamivudine and developed drug resistance should be placed on tenofovir. • Duration of treatment is likely life-long. Stopping treatment can result in hepatitis flare. •Long-term Monitoring recommendations• Blood test for ALT level to monitor for treatment response and hepatitis flare every 6 months. Blood test for creatinine every 6 -12 months to monitor kidney function if taking tenofovir. • Blood test for hepatitis B DNA level 3 - 6 months after starting treatment to evaluate treatment response. Repeat if ALT level becomes elevated on treatment and if feasible once a year. • Blood test for alpha fetoprotein (AFP) level every 6 months and liver ultrasound every 6-12 months for liver cancer screening (Particularly important if the patient has cirrhosis or a family history of liver cancer.) • Avoid drinking alcohol and moldy food. Advise the patient to receive the hepatitis A vaccine if unprotected and the patient’s family and partner to get tested for hepatitis B and get vaccinated if they are not protected. |
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The result shows antiviral treatment is not indicated at this time•Even though treatment is not indicated for now, the chronically infected person still has a risk of developing liver cancer and active hepatitis that would require treatment in the future. It is important to follow long-term monitoring recommendations.•Long-term Monitoring recommendations• Blood test for ALT level to monitor for active hepatitis every 6-12 months. When ALT becomes elevated, repeat HBV DNA level to check for increased viral activity. • Blood test for alpha fetoprotein (AFP) level every 6 months and liver ultrasound every 6-12 months for liver cancer screening (Regular liver cancer screening is particularly important if there is a family history of liver cancer) • Baseline blood test for anti-HBe. Blood test for HBV DNA level once a year if feasible to monitor viral activity. •Circumstances where prophylactic antiviral treatment is recommended• To prevent hepatitis flare while receiving or following immunosuppressive therapy, or receiving antiviral therapy for hepatitis C • To further reduce the risk of mother to child transmission in pregnant women with very high hepatitis B DNA level (>200,000 IU/mL) with TDF from 28 weeks of pregnancy to birth •Avoid drinking alcohol and moldy food. Advise the patient to receive the hepatitis A vaccine if unprotected and the patient’s family and partner to get tested for hepatitis B and get vaccinated if they are not protected. |
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