Keeffe et al reported recommendations for treating a patient infected with hepatitis B virus (HBV). One category involves patients who are HBeAg-positive and without cirrhosis. The authors are from multiple universities in the United States.
Patient selection: HBeAg-positive, without cirrhosis
Parameters:
(1) HBV copies in IU/mL
(2) serum ALT
HBV copies
Serum ALT
Recommendations
< 20,000 IU/mL
normal
Monitor every 3 months for 1 year, then every 6-12 months. Therapy may be indicated if liver biopsy shows significant disease.
>= 20,000 IU/mL
normal
Therapy may be indicated if liver biopsy shows significant disease. Else monitor for elevation of serum ALT.
>= 20,000 IU/mL
elevated
Treat with antiviral agents.
Liver biopsy may be helpful in guiding patients with a normal serum ALT, especially if the patient is >= 35 years of age.
Patients with HBeAg show a low rate of seroconversion for all treatments.
Use adefovir, entecavir or peginterferon alfa-2a as first-line options.
Peginterferon alfa-2a is preferred if the patient has genotype A.
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