Initial evaluation |
1. History and physical examination* |
2. Family history of HBV infection, liver disease, HCC |
3. Laboratory tests to assess liver disease - complete blood counts with platelets, aminotransferase levels, total bilirubin, alkaline phosphatase, albumin, and INR |
4. Tests for HBV replication - HBeAg, anti-HBe, HBV DNA |
5. Tests to rule out viral coinfections - anti-HCV, anti-HDV (in persons from countries where HDV infection is common and in those with history of injection drug use), and anti-HIV¶ |
6. Tests to screen for HCCΔ - (eg, ultrasound) |
7. Tests to screen for fibrosis◊ - vibration-controlled transient elastography, serum fibrosis panel, or liver biopsy§ |
Suggested follow-up for patients not considered for treatment: HBeAg+, HBV DNA >20,000 international units/mL, and normal ALT without cirrhosis¥ |
ALT every 3 to 6 months and HBeAg every 6 to 12 months |
If ALT levels increase between 1 to 2 x ULN‡:
|
If ALT increases to >2 x ULN‡ for 3 to 6 months and HBeAg+, HBV DNA >20,000 international units/mL, recommend treatment |
Screen for HCC in relevant populationΔ |
Suggested follow-up for patients not considered for treatment: HBeAg-, HBV DNA <2000 international units/mL, and normal ALT without cirrhosis¥ |
ALT and HBV DNA every 3 months for 1 year, if persistently normal, ALT and HBV DNA every 6 to 12 months† |
If ALT increases between 1 to 2 x ULN‡:
|
If ALT increases to >2 x ULN, recommend treatment if HBV DNA >2000 international units/mL |
If HBV DNA increases to >2000 international units/mL, recommend treatment if ALT > 2 x ULN. If ALT <2 x ULN, assess liver fibrosis by biopsy or noninvasive tests. Recommend treatment if moderate/severe inflammation or significant fibrosis is present.§ |
Screen for HCC in relevant population |