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The American Association for the Study of Liver Disease has made
recommendations for treating long-term (chronic)
hepatitis B. These recommendations are based on the
presence of hepatitis B
antigens in your blood, the level of hepatitis B viral
DNA (HBV DNA) in your blood, and the level of the liver
enzyme alanine aminotransferase (ALT).
Chronic hepatitis B can be HBeAg-positive or -negative. This means a
specific hepatitis B antigen (HBeAg) is present (positive) or is not present
(negative) in your blood. High levels of HBV DNA and liver enzymes may be
present in both of these types of chronic hepatitis. This points to an active
viral infection and increased risk of liver damage.
Treatment with antiviral medicine is recommended if you
Treatment with antiviral medicine is not recommended if you
If you are either HBeAg-positive or -negative, have low levels of HBV
DNA, and have cirrhosis, you may be monitored or may need a liver
The European Association for the Study of the Liver (EASL) also has guidelines for the treatment of chronic hepatitis B. According to the EASL, treatment should be considered for people with high levels of HBV DNA and/or higher-than-normal levels of the liver enzyme ALT, and moderate to severe liver inflammation. But the decision to treat should also consider a person's general health, age, and availability of antiviral medicines.2
Lok SFL, McMahon BJ (2009). Chronic Hepatitis B: Update 2009. Available online: http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Chronic_Hep_B_Update_2009%208_24_2009.pdf.
European Association for the Study of the Liver (2012). EASL Clinical Practice Guidelines: Management of chronic hepatitis B. Journal of Hepatology, 57(1): 167–185.
October 29, 2012
Kathleen Romito, MD - Family Medicine & W. Thomas London, MD - Hepatology
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