Whether to treat chronic hepatitis B depends on the phase of infection, which needs four pieces of information: HBeAg status, HBV DNA level, ALT, and fibrosis stage, ideally by elastography. Add age and family history of HCC or cirrhosis.
A single ALT is not enough, because ALT fluctuates and normal ranges vary. Repeat ALT and HBV DNA over time in patients not started on treatment, and reassess the phase at each review.
- Check HBeAg, HBV DNA, ALT and fibrosis by elastography in every patient with chronic hepatitis B
- Ask about family history of HCC and cirrhosis
- Repeat ALT and HBV DNA regularly in untreated patients rather than relying on one result
- Reassess the phase of infection at every review
Why it matters
The treatment decision is only as good as the phase assessment behind it.
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