Management of HBsAg-Reactive Patients on Tenofovir

Essential Laboratory Monitoring

The American Association for the Study of Liver Diseases recommends checking HBV DNA by PCR at the annual visit to confirm viral suppression, with a target of undetectable or <69 IU/mL 2, 3, 1
The American Association for the Study of Liver Diseases suggests monitoring ALT/AST to assess hepatic inflammation and treatment response 4, 1
The National Kidney Foundation recommends monitoring serum creatinine and calculated creatinine clearance every 3 months in at-risk patients, but at minimum every 12 weeks for all patients on tenofovir 3, 5
The American Association for the Study of Liver Diseases recommends monitoring serum phosphorus every 3 months in patients at risk for renal toxicity 3
The American Association for the Study of Liver Diseases suggests annual quantitative HBsAg testing to assess for potential functional cure (HBsAg loss) 1
The American Association for the Study of Liver Diseases recommends checking HBeAg/anti-HBe status every 6 months to monitor for seroconversion in initially HBeAg-positive patients 4

The American College of Gastroenterology recommends initiating or continuing ultrasound screening every 6 months if the patient meets certain criteria, such as Asian men >40 years or Asian women >50 years 1
The American College of Gastroenterology suggests screening for hepatocellular carcinoma in patients with cirrhosis 1
The American College of Gastroenterology recommends screening for hepatocellular carcinoma in patients >40 years with persistent ALT elevation 1
The American College of Gastroenterology suggests screening for hepatocellular carcinoma in patients with a family history of HCC 6

The American Association for the Study of Liver Diseases reports that at 8 years of tenofovir treatment, 98-99.6% of patients should have undetectable HBV DNA 2, 3
The American Association for the Study of Liver Diseases states that no resistance to tenofovir has been documented through 10 years of treatment 2, 3

The Centers for Disease Control and Prevention recommends screening for anti-HCV antibody if not already completed 6
The Centers for Disease Control and Prevention suggests screening for anti-HDV antibody, especially if there is a history of injection drug use 1
The Centers for Disease Control and Prevention recommends screening for anti-HIV antibody if not already completed 6
The Centers for Disease Control and Prevention suggests vaccinating against hepatitis A if anti-HAV antibody is negative, as coinfection increases mortality 5.6- to 29-fold 1

The American Association for the Study of Liver Diseases recommends indefinite treatment with tenofovir for most patients 1
The American Society of Clinical Oncology recommends continuing tenofovir prophylaxis throughout chemotherapy or immunosuppressive therapy and for at least 12 months after cessation 6, 7, 1

The American Society of Clinical Oncology recommends monitoring HBV DNA every 6 months during antiviral therapy in patients undergoing chemotherapy or immunosuppressive therapy 6, 7

The American Association for the Study of Liver Diseases warns against attributing virologic breakthrough solely to resistance, as nonadherence or drug interactions are more likely causes 2
The American Association for the Study of Liver Diseases recommends not delaying HCC surveillance, as screening should begin immediately for high-risk patients and continue indefinitely regardless of viral suppression 1