Hepatitis B Treatment Recommendations
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 are:
- HBeAg-positive and have high levels of HBV DNA, and your ALT level is more than twice the normal level.
- HBeAg-negative and have lower levels of HBV DNA, and your ALT level is more than twice the normal level.
- Either HBeAg-positive or negative, have high levels of HBV DNA, and have cirrhosis.
Treatment with antiviral medicine is not recommended if you are:
- HBeAg-positive and have high levels of HBV DNA, and your liver enzymes are less than twice the normal level.
- HBeAg-negative and have low levels of HBV DNA, and your liver enzymes are less than twice the normal level.
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 transplant.
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.footnote 3
- Terrault, et al. (2016). AASLD guidelines for treatment of chronic hepatitis B. Hepatology, 63(1): 261–283. DOI: 10.1002/hep.28156. Accessed May 21, 2018.
- 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.
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Adam Husney, MD - Family Medicine
Specialist Medical Reviewer W. Thomas London, MD - Internal Medicine, Hepatology
Current as ofNovember 18, 2017
Current as of: November 18, 2017