Tenofovir Initiation Guidelines

Chronic Hepatitis B Treatment

The American Association for the Study of Liver Diseases recommends starting tenofovir (or entecavir) when HBV DNA >2000 IU/mL with elevated ALT or evidence of significant fibrosis in HBeAg-positive patients 1
The European Association for the Study of the Liver recommends initiating long-term treatment regardless of HBV DNA level in patients with compensated cirrhosis 3
For decompensated cirrhosis, life-long treatment is mandatory, as recommended by the American Association for the Study of Liver Diseases 3
The American Association for the Study of Liver Diseases recommends initiating therapy with the same criteria: HBV DNA >2000 IU/mL plus elevated ALT or significant fibrosis in HBeAg-negative patients 1
Treatment should continue until HBsAg clearance is achieved, as recommended by the European Association for the Study of the Liver 3

The American Gastroenterological Association recommends that all HBsAg-positive patients start tenofovir (or entecavir) ideally 2 weeks before beginning immunosuppressive therapy or chemotherapy, regardless of HBV DNA level 4, 2
The American Gastroenterological Association recommends continuing treatment during and for at least 12 months after cessation of immunosuppressive therapy (6 months for non-rituximab regimens) 2

The Centers for Disease Control and Prevention recommends initiating tenofovir-containing antiretroviral therapy immediately upon HIV diagnosis in all HBsAg-positive patients 5, 6
The World Health Organization recommends combining tenofovir with emtricitabine or lamivudine as part of a complete antiretroviral regimen 5, 7
The American Association for the Study of Liver Diseases recommends not using tenofovir as monotherapy in HIV/HBV coinfected patients—always use as part of appropriate combination antiretroviral therapy 3

The American College of Obstetricians and Gynecologists recommends starting tenofovir at 24-32 weeks of gestation in HBsAg-positive pregnant women with HBV DNA >200,000 IU/mL to prevent perinatal transmission 1, 2
The American College of Obstetricians and Gynecologists recommends continuing or switching to tenofovir immediately for women with advanced fibrosis or cirrhosis who become pregnant 1

The American Association for the Study of Liver Diseases recommends immediate initiation of tenofovir in decompensated cirrhosis 3
The American Gastroenterological Association recommends immediate initiation of tenofovir before starting high-risk immunosuppression (ideally 2 weeks prior) 4, 2
The Centers for Disease Control and Prevention recommends immediate initiation of tenofovir in HIV diagnosis in HBsAg-positive patients 5, 6

The American Association for the Study of Liver Diseases recommends never discontinuing tenofovir abruptly in HBV-infected patients, as severe hepatitis flares can occur, particularly without HBeAg seroconversion 3, 10
The European Association for the Study of the Liver recommends assessing renal function (creatinine clearance) before initiating tenofovir and monitoring periodically, especially in patients at risk for renal dysfunction is not applicable due to [ignore ref]
The American Association for the Study of Liver Diseases recommends starting tenofovir if HBV DNA >2000 IU/mL to reduce viral load before resuming exposure-prone procedures in healthcare workers 1