Chronic Hepatitis B Treatment Decision Tool For Adults
| Question | Answer |
|---|---|
| Does your patient have CIRRHOSIS? | |
| 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). • AAvoid 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 (Particularly important if there is a family history of liver cancer). • Baseline blood test for HBeAg and 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 or HBeAg positive if antenatal HBV DNA testing is not available) 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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