Chronic Hepatitis B and C Treatment Guidelines

Chronic Hepatitis B Treatment

The American Association for the Study of Liver Diseases recommends treating chronic hepatitis B patients with entecavir or tenofovir, as these achieve superior potency and minimal resistance rates 1, 2
For HBeAg-positive patients, treatment should be initiated when HBV DNA is greater than 20,000 IU/mL and ALT is greater than 2 times the upper limit of normal 1, 2
The European Association for the Study of the Liver recommends treating HBeAg-positive patients for a minimum of 1 year, then 3-6 months after HBeAg seroconversion 3, 1, 2
For cirrhotic patients, treatment with entecavir or tenofovir should be lifelong due to the risk of decompensation upon discontinuation 1
Entecavir achieves greater than 90% virologic suppression after 3 years with less than 1% resistance at 4 years in treatment-naive patients 1

The European Association for the Study of the Liver recommends treating chronic hepatitis C patients with direct-acting antivirals, as these achieve sustained virological response rates greater than 90% and reduce HCC risk by greater than 70% 6, 7
All patients with chronic HCV should receive DAA therapy regardless of fibrosis stage 7
Sustained virological response reduces HCC incidence by greater than 70% and all-cause mortality, and prevents cirrhosis progression 6

In HBV-HCV coinfection, treat the HCV with standard DAA regimens while providing concurrent HBV nucleos(t)ide analogue therapy if HBsAg-positive or HBV DNA detectable 7, 8
The American Association for the Study of Liver Diseases recommends testing for HBsAg, anti-HBc antibodies, anti-HBs antibodies, and HBV DNA prior to treatment 7, 8
Entecavir and tenofovir are recommended for HBV treatment in coinfection, and renal function should be monitored if using ledipasvir with tenofovir due to increased renal toxicity risk 10