HBeAg negative2012 .pdf


Nom original: HBeAg-negative2012.pdfTitre: HBeAg-negative.pdfAuteur: baby

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Liver biopsy

ALT every 6 mo*

Persistently ALT <ULN and
HBV DNA <2000 IU/ml

ALT >ULN and/or,
HBV DNA >20,000 IU/ml and/or
liver stiffness >9 kPa

ALT every 6 mo,
HBV DNA every year and
transient elastography every year

ALT <ULN and
HBV DNA 2000-20,000 IU/ml

ALT every 3-4 mo,
HBV DNA every year and
transient elastography every year
for two more years

Persistently ALT <ULN and
HBV DNA 2000-20,000 IU/ml

Fig. 1. Clinical algorithm for the optimal follow-up and management of patients with HBeAg-negative chronic HBV infection and normal alanine aminotransferase
(ALT) activity at baseline. All patients should have ALT and HBV DNA monitoring every 3–4 months during the first year. Patients with ALT persistently below ULN and HBV
DNA <2000 IU/ml during the first year may be monitored with ALT every 6 months. ⁄Periodical HBV DNA measurements may be also helpful, although the optimal
frequency of HBV DNA monitoring is unclear. Patients with ALT persistently below the upper limit of normal (<ULN) and HBV DNA 2000–20,000 IU/ml during the first year
should undergo transient elastography and continue every 3–4 months ALT and annual HBV DNA and transient elastography monitoring during the second and third year
because of a higher risk of exacerbations during the first 3 years, and then ALT every 6 months together with HBV DNA and transient elastography every year. Patients with
abnormal ALT, HBV DNA >20,000 IU/ml and/or liver stiffness >9 kPa should be considered for liver biopsy and treatment. The optimal liver stiffness cut-off for liver biopsy
needs further evaluation. All patients, including those with persistently normal ALT and HBV DNA <2000 IU/ml, should be monitored for life.

Liver biopsy

ALT >ULN and/or
HBV DNA >20,000 IU/ml

ALT every 3-4 mo for one year
+ serum HBV DNA determination

HBeAg-negative patient with normal ALT at baseline


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