Management of Treatment of Chronic Hepatitis B

1. Goals of therapy and treatment endpoints for Chronic Hepatitis B:

* Goal of therapy: Long term viral suppression to prevent long term clinical outcomes such as death from liver disease and development of liver cancer.

* Treatment endpoint:

- Improve liver histology

- Normalize ALT

- Decrease HBV DNA

- HBeAg loss and seroconversion to Anti-HBe or to Anti-HBs (+)

2. APASL 2008 Guidelines for Hepatitis (1): Starting treatment

- HBV DNA> 100,000 copies/mL (20,000IU/mL) in HBeAg-positive patients

- Or HBV DNA> 10,000 copies/mL (2000 IU/mL) in HBeAg-negative patients

- ALT > 2 x upper limit of normal.

3. EASL 2009 Guidelines for Hepatitis (2): For both HBeAg+ve and HBeAg-ve Chronic Hepatitis B

- HBV DNA> 200IU/mL (approximately 10^4 copies/mL) and/or

- ALT > ULN and

- Live biopsy showing moderate to severe active necroinflammation and/or fibrosis using a standardized scoring system.

Reference:

1. Liaw FW et al. Hepatol Int 2008; 2: 263-83

2. EASL Practice Guidelines J Hepatol 2009; 50: 227-42