Many people with chronic hepatitis B have normal ALT for years, which can be read as inactive disease. Viral load, HBeAg status, age, family history of liver cancer and fibrosis assessment all change the risk picture. Review each of these at least yearly, and refer when viral load is high or fibrosis is present, even if ALT is normal.
- Check HBeAg status and HBV DNA, not just ALT.
- Assess fibrosis with elastography or a validated score.
- Ask about family history of liver cancer at every review.
Why it matters
Relying on ALT alone can leave high-risk patients untreated.
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