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Management of Hepatitis B Infection - Authors: Harry L. A. Janssen, MD, PhD; Milan J. Sonneveld, MSc (More Info)
- Editor In Chief: Stefan Zeuzem, MD
- Last Reviewed: 2/24/17 (What's New)
Monitoring of Patients Who Are Not Candidates for Therapy Summary - Patients who are not candidates for immediate anti-HBV therapy should be closely monitored[Terrault 2016; Lok 2009]
- HBeAg-positive patients with immunotolerant disease should receive liver function tests every 3-6 months and HBeAg tests every 6-12 months
- HBeAg-negative patients who are inactive HBsAg carriers should be assessed every 3 months during the first year and biannually thereafter
- Patients with low HBV DNA and HBsAg levels may need less frequent monitoring
Patients who are not candidates for immediate initiation of therapy should be closely monitored. Hepatitis B e antigen (HBeAg)–positive patients with HBV DNA > 20,000 IU/mL but normal ALT levels and an absence of necroinflammation on the liver biopsy (ie, so-called immunotolerant patients) should have their alanine aminotransferase (ALT) levels measured at least every 6 months and should be regularly tested for the presence of HBeAg (approximately every 6-12 months)(Management Guidelines).[Terrault 2016; Lok 2009] In HBeAg-negative patients with HBV DNA < 2000 IU/mL and normal ALT (ie, so-called inactive hepatitis B surface antigen [HBsAg] carriers), ALT and HBV DNA levels should be reassessed every 3 months during the first year, with subsequent biannual assessments.[Lok 2009] Patients with low levels of serum HBV DNA (< 2000 IU/mL), as well as low levels of HBsAg (< 1000 IU/mL), may perhaps require less frequent monitoring due to a very low probability of disease reactivation. [Brunetto 2010]
Keywords: Hepatitis B, Hepatitis B-Monitoring, Hepatitis B-Treatment
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