Table 3: Recommendation for treatment in HBeAg- CHB

HBeAg   HBVDNA(a)   ALT      
         
- < 104 normal No treatment
      Monitor every 6 - 12 months
         
- > 104 normal No treatment
      Monitor and treat when ALT
      Treat if liver biopsy shows moderate/ severe necroinflammation
         
- > 104 elevated(b) Peg-IFN 2a, 1 year
    (> 2 x ULN) Lamivudine
      Adefovir
               
(a) HBVDNA 104 copies/ml is chosen because HBeAg- CHB has lower HBVDNA level compared with HBeAg+ CHB.
(b) Choice of treatment depends on
  - duration of treatment (1 year in Peg-IFN vs long term LAM/ADV)  
  - underlying liver function
  - long term efficacy of treatment
  - side effects, cost
  - patient preference
 
When to stop treatment
  - Peg-IFN a2a, 1 year
- Lamivudine, Adefovir
 
Optimal duration unknown (AASLD,EASL)
Persistent HBVDNA-ve (PCR) and normal ALT on 3 occasions for at least 6 months, provided there is no severe underlying liver disease (APASL)
 
   
AASLD - American Association for the Study of Liver Diseases
EASL - European Association for the Study of Liver Diseases
APASL - Asian Pacific Association for the Study of Liver Diseases