Hepatitis B - Treatment Indications Treatment not indicated: • Immune tolerant state - HBe-Ag detectable, high HBV DNA (>10^6 IU/mL), normal ALT, age < 30-40 years • Low replicative state - HBe-Ag undetectable, low HBV DNA (<2000 IU/mL), normal ALT Treatment possibly indicated: • HBe-Ag detectable, high HBV DNA (>10^6 IU/mL), normal ALT, and age > 30-40 years • Presence of CP or PC mutation • HBV genotype C • Age > 30-40 years • Moderate immunosuppression* • Extrahepatic manifestations of HBV • HIV/HCV co-infection • Family history of cirrhosis • Personal or family history of HCC Treatment Indicated: • HBV DNA > 2000 IU/mL and ALT > 2xULN • HBV DNA > 2000 IU/mL and ALT > ULN, with moderate necroinflammatory activity and/or fibrosis • Cirrhosis • Pregnancy with HBV DNA > 200,000 IU/mL (begin for vertical transmission prophylaxis at 28-32 weeks gestation) • Use of B-cell depleting agents or marked immunosuppression • Acute HBV infection with severe liver injury (INR > 2, bilirubin > 3 mg/dL) or acute liver failure #HepatitisB #HepBV #HBV #Treatment #Indications #management #hepatology
