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1.5 Antiviral treatment
1.5.1 Discuss treatment options, adverse effects and long-term prognosis with the patient before starting treatment.
1.5.2 Offer antiviral treatment to adults aged 30 years and older who have HBV DNA >2000 IU/ml and abnormal ALT (≥30 in males and ≥19 in females) on 2 consecutive tests conducted 3 months apart.
1.5.3 Offer antiviral treatment to adults younger than 30 years who have HBV DNA >2000 IU/ml and abnormal ALT (≥30 in males and ≥19 in females) on 2 consecutive tests conducted 3 months apart if there is evidence of necroinflammation or fibrosis on liver biopsy or a transient elastography score >6 kPa.
1.5. Offer antiviral treatment to adults who have HBV DNA >20,000 IU/ml and abnormal ALT (≥30 in males and ≥19 in females) on 2 consecutive tests conducted 3 months apart regardless of age or the extent of liver disease.
1.5.5 Offer antiviral treatment to adults with cirrhosis regardless of HBeAg status, HBV DNA and ALT levels.
1.5.6 Consider antiviral treatment in adults with HBV DNA >2000 IU/ml and evidence of necroinflammation or fibrosis on liver biopsy.
1.5.7 Peginterferon alfa-2a is recommended as an option for the initial treatment of adults with chronic hepatitis B (HBeAg-positive or HBeAg-negative), within its licensed indications. [This recommendation is from Adefovir dipivoxil and peginterferon alfa-2a for the treatment of chronic hepatitis B (NICE technology appraisal guidance 96).]
1.5.8 Entecavir, within its marketing authorisation, is recommended as an option for the treatment of people with chronic HBeAg-positive or HBeAg-negative hepatitis B in whom antiviral treatment is indicated. [This recommendation is from Entecavir for the treatment of chronic hepatitis B (NICE technology appraisal guidance 153).]
1.5.9 Tenofovir disoproxil, within its marketing authorisation, is recommended as an option for the treatment of people with chronic HBeAg-positive or HBeAg-negative hepatitis B in whom antiviral 8 treatment is indicated. [This recommendation is from Tenofovir disoproxil fumarate for the treatment of hepatitis B (NICE technology appraisal guidance 173).]
1.5.10 Telbivudine is not recommended for the treatment of chronic hepatitis B. [This recommendation is from Telbivudine for the treatment of chronic hepatitis B (NICE technology appraisal guidance 154).]
1.5.11 People currently receiving telbivudine should have the option to continue therapy until they and their clinicians consider it appropriate to stop. [This recommendation is from Telbivudine for the treatment of chronic hepatitis B (NICE technology appraisal guidance 154).]
1.5.12 Adefovir dipivoxil is not recommended for the treatment of chronic hepatitis B.
1.5.13 Offer tenofovir disoproxil or entecavir to people currently receiving adefovir dipivoxil, depending on previous antiviral exposure: offer tenofovir disoproxil to people with a history of lamivudine resistance.
1.5.14 Antiviral treatment should be initiated only by an appropriately qualified healthcare professional with expertise in the management of viral hepatitis. Continuation of therapy under shared-care arrangements with a GP is appropriate.
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