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Asian Liver Center

at Stanford University

780 Welch Road, CJ 130
Palo Alto, CA 94304

Stephanie Chao, M.D.
Voice: (650) 736-8608
Fax: (650) 736-8001


 
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Antiviral Treatment

When is antiviral treatment not appropriate

Normal ALT 
There is no evidence to support treatment of these patients, regardless of their HBV DNA or HBeAg status.  However, they are still at risk for liver cancer and flare up of hepatitis, and should be screened regularly.

When is treatment for chronic HBV appropriate

Elevated ALT (>2x normal)
Low or undetectable HBV DNA
HBeAg (+) 

These chronic HBV patients show signs of active liver damage associated with high viral activity and it is reasonable to consider treatment by oral antivirals or injection immunostimulators.

Elevated ALT (>2x normal)
Elevated HBV DNA (>20,000 IU/mL)
HBeAg (-) 

These chronic HBV patients show signs of active liver damage caused by a mutant strain of HBV that does not secrete HBeAg.  It is reasonable to consider treatment by oral antivirals or injection immunostimulators.

 

Cirrhosis

Normal or elevated ALT
Detectable HBV DNA 

For patients with compensated or decompensated cirrhosis consider HBV treatment by oral antivirals, regardless of HBeAg. 

Cancer chemotherapy
Normal or elevated ALT
Detectable or undetectable HBV DNA

When the immune system is suppressed during chemotherapy, flare-up of the HBV infection can lead to fulminant hepatitis and death.  Therefore, HBsAg-positive patients undergoing chemotherapy should be placed on prophylactic oral antiviral treatment, regardless of pre-treatment ALT, HBV DNA or HBeAg levels.