Table 2: Recommendation for treatment in HBeAg+ CHB

HBeAg   HBVDNA   ALT      
+ < 105   normal   No treatment
            Monitor every 6-12m
               
+ > 105   normal   No treatment because low rate of e-seroconversion
            Monitor and consider Rx when ALT
            Treat if liver biopsy shows moderate / severe necroinflammation
+ > 105   elevated   Observe for 3 months if liver is compensated, see if spontaneous e-seroconversion occurs
               
        (a)   Peginterferon 2a: 1/2 year
        2-5xULN   Peginterferon 2b: 1/2 year
            Lamivudine
            Adefovir
               
        >5 x ULN   Lamivudine is recommended because of risk of decompensation with IFN
               
a) Choice of treatment should be individualized, depends on underlying liver function, side effects of treatment, cost, patient preference.
 
When to stop treatment
  - Peginterferon a2a, a2b - 1/2 year
  - Lamivudine and Adefovir e-seroconversion and HBV DNA <105 copies/ml, on 2 occasions at least 6 months apart.