Last updated March 14, 2022

Treatment of Chronic Hepatitis B

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
(CVL)
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  • renal
(CL)
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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

Publication Month/Year

January 1, 2016

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