Treatment of Chronic Hepatitis B
Publication Date: January 1, 2016
Last Updated: March 14, 2022
Recommendations
Treatment of Persons With Immune-Active CHB
The AASLD recommends antiviral therapy for adults with immune-active CHB (HBeAg negative or HBeAg positive) to decrease the risk of liver-related complications. (SM)
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The AASLD recommends Peg-IFN, entecavir, or tenofovir as preferred initial therapy for adults with immune-active CHB. (SL)
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Treatment of Adults With Immune-Tolerant CHB
The AASLD recommends against antiviral therapy for adults with immune-tolerant CHB. (SM)
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The AASLD suggests that ALT levels be tested at least every 6 months for adults with immunetolerant CHB to monitor for potential transition to immune-active or -inactive CHB. (CVL)
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The AASLD suggests antiviral therapy in the select group of adults >40 years of age with normal ALT and elevated HBV DNA (1,000,000 IU/mL) and liver biopsy showing significant necroinflammation or fibrosis. (CVL)
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Treatment of HBeAg Positive Immune-Active Chronic Hepatitis Persons Who Seroconvert to Anti-HBe on NA Therapy
The AASLD suggests that HBeAg-positive adults without cirrhosis with CHB who seroconvert to anti-HBe on therapy discontinue NAs after a period of treatment consolidation. (CVL)
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The AASLD suggests indefinite antiviral therapy for HBeAg-positive adults with cirrhosis with CHB who seroconvert to anti-HBe on NA therapy, based on concerns for potential clinical decompensation and death, unless there is a strong competing rationale for treatment discontinuation. (CVL)
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Duration of Treatment in Persons With HBeAg-Negative Immune-Active CHB
The AASLD suggests indefinite antiviral therapy for adults with HBeAg-negative immune-active CHB, unless there is a competing rationale for treatment discontinuation. (CL)
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Renal and Bone Disease in Persons on NA Therapy
The AASLD suggests no preference between entecavir and tenofovir regarding potential long-term risks of renal and bone complications.
- bone
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- renal
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Management of Persons With Persistent Low-Level Viremia on NA Therapy
The AASLD suggests that persons with persistent low-level viremia (<2,000 IU/mL) on entecavir or tenofovir monotherapy continue monotherapy, regardless of ALT. (CVL)
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The AASLD suggests one of two strategies in persons with virological breakthrough on entecavir or tenofovir monotherapy: either switch to another antiviral monotherapy with high barrier to resistance or add a second antiviral drug that lacks crossresistance. (CVL)
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Management of Adults With Cirrhosis and Low-Level Viremia
The AASLD suggests that adults with compensated cirrhosis and low levels of viremia (<2,000 IU/ mL) be treated with antiviral therapy to reduce the risk of decompensation, regardless of ALT level. (CVL)
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The AASLD recommends that HBsAg-positive adults with decompensated cirrhosis be treated with antiviral therapy indefinitely regardless of HBV DNA level, HBeAg status, or ALT level to decrease risk of worsening liver-related complications. (SM)
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Treatment of CHB in Pregnancy
The AASLD suggests antiviral therapy to reduce the risk of perinatal transmission of hepatitis B in HBsAg-positive pregnant women with an HBV DNA level >200,000 IU/mL. (CL)
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The AASLD recommends against the use of antiviral therapy to reduce the risk of perinatal transmission of hepatitis B in the HBsAg-positive pregnant woman with an HBV DNA 200,000 IU/mL. (SL)
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Treatment of CHB in Children
The AASLD suggests antiviral therapy in HBeAgpositive children (ages 2 to <18 years) with both elevated ALT and measurable HBV DNA levels, with the goal of achieving sustained HBeAg seroconversion. (CM)
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The AASLD recommends against use of antiviral therapy in HBeAg-positive children (ages 2 to <18 years) with persistently normal ALT, regardless of HBV DNA level. (SVL)
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Recommendation Grading
Overview
Title
Treatment of Chronic Hepatitis B
Authoring Organization
American Association for the Study of Liver Diseases
Publication Month/Year
January 1, 2016
Last Updated Month/Year
June 1, 2023
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Guideline developers from the AASLD formulated a list of discrete questions that physicians are faced with in daily practice.
Target Patient Population
Patients with chronic hepatitis B
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Hospital, Long term care, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management, Treatment
Diseases/Conditions (MeSH)
D006509 - Hepatitis B, D019694 - Hepatitis B, Chronic, D017325 - Hepatitis B Vaccines, D006515 - Hepatitis B virus
Keywords
hepatitis B, hepatitis, chronic hepititis
Source Citation
TERRAULT ET AL. HEPATOLOGY, Vol. 63, No. 1, 2016