Management of Chronic Hepatitis B

Interpretation of Serologic Profile

Positive HBsAg for more than 6 months defines chronic HBV infection, as indicated by the American Association for the Study of Liver Diseases 1, 2
Positive anti-HBc total indicates previous or ongoing HBV infection, according to the American Association for the Study of Liver Diseases 1
Positive anti-HBe with negative HBeAg suggests HBeAg-negative chronic hepatitis B, as stated by the European Association for the Study of the Liver 1, 3
Negative anti-HBs confirms lack of protective immunity, as noted by the American Association for the Study of Liver Diseases 2

Measure serum HBV DNA level to determine viral replication status, a critical step in distinguishing between inactive carrier state and HBeAg-negative chronic hepatitis B, as recommended by the American Association for the Study of Liver Diseases 1, 2
Check liver enzymes, such as AST/ALT, to assess hepatic inflammation, as suggested by the European Association for the Study of the Liver 3, 4
Complete blood count, alkaline phosphatase, gamma-glutamyl transpeptidase, bilirubin, albumin, creatinine, and prothrombin time to evaluate liver function, as recommended by the American Association for the Study of Liver Diseases 4
Test for coinfections, including anti-HCV, anti-HDV, and anti-HIV, as advised by the Centers for Disease Control and Prevention 2, 4

If HBeAg-negative chronic hepatitis B, defined by HBV DNA >2,000 IU/mL and elevated ALT, the American Association for the Study of Liver Diseases recommends initiating antiviral therapy with high barrier to resistance agents, such as entecavir, tenofovir disoproxil fumarate, or tenofovir alafenamide 1, 3, 5
If inactive carrier state, defined by HBV DNA <2,000 IU/mL and normal ALT, regular monitoring without immediate antiviral therapy is recommended by the European Association for the Study of the Liver 1, 3, 4

Assess for risk of HBV reactivation if immunosuppressive therapy is planned, and consider prophylactic antiviral therapy, as recommended by the American Gastroenterological Association 5, 6
Screen for hepatocellular carcinoma with ultrasound examination every 6 months, as advised by the American Association for the Study of Liver Diseases 4
Vaccinate against hepatitis A if not immune, as recommended by the Centers for Disease Control and Prevention 2, 4

For patients on antiviral therapy, check HBV DNA, ALT, and renal function every 3-6 months, as recommended by the American Association for the Study of Liver Diseases 2
Long-term therapy is typically required for HBeAg-negative chronic hepatitis B, as stated by the European Association for the Study of the Liver 5