Decision for treatment for chronic hepatitis B, when should we treat ???

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18 Jul 2016 - General

When should we treat patient with chronic hepatitis B ?? Not all the patients with chronic hepatitis B will be benifit from the treatment. The cohort of patients with chronic hepatitis B that will benefit from treatment are patients with detectable viremia and evidence of ongoing liver necrosis (like increasing liver enzyme, liver biopsy showed active inflammation or fibrosis). Patients will usually test positive for hepatitis B e antigen (HBeAg), and negtive for HBe antibodies (HBeAb), with high level of hepatitis B virus DNA. Patients that are chronic hepatitis B carriers, with HBsAg positive, HBeAg negative, HBeAb positive, non-detectable or low HBV DNA viral load, do not require active antiviral treatment, will only require monitoring. 

(B)HBeAg–negative hepatitis B virus infection and: i) ALT < ULN: Monitor ALT 3 months later. If still normal, monitor ALT every 6 to 12 monthly. ii) ALT 1-2X ULN: Monitor ALT 3 to 6 monthly. Refer to specialist if persistent, evidence of early deterioration of liver function or age > 40. If HBV DNA is > 2000 IU/ml, consider liver biopsy and treat if biopsy shows significant liver damage. iii) ALT > 2X ULN: repeat ALT within 1 to 3 months. Refer to specialist if persistent. If HBV DNA...
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Summarize so you mean :Management of patients with chronic hepatitis B should be tailored according to the patients’ clinical state of liver disease (compensated versus decompensated liver disease) as well as their virologic and biochemical (i.e. the liver function test, in particular the serum transaminase levels) status. 1) For patients with HBsAg positive > 6 months and well–compensated liver disease, in association with: (A)HBeAg–positive hepatitis B virus infection and: i) Alanine aminot...
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