A 26 years old man was found to be HBsAg positive but HBeAg negative and ALT/AST normal, what will be the next step in his management?
ANSWER: (A) Serial monitoringREF: Harrison's 17th ed page 1957-1962The patient profile indicates that he is either in a non-reactive state or inactive carrier of chronic hepatitis; such patients are usually monitored sequentially.Markers for active replication - HbeAG, HBV- DNAAntiviral therapy is best indicated for patients with active replicationRecommendations for Treatment of Chronic Hepatitis B:HBeAgStatusClinicalHBV DNA(copies/mL)ALTRecommendationHBeAg-reactiveClinically inactive<l05Normal(2 x ULN)No treatment; monitor Chronic hepatitis105NormalNo treatment; current treatment of limited (2 x ULN)benefit (Some suggest liver biopsy and treating if abnormal) Chronic hepatitis105Elevated (>2 x ULN)bTreat Cirrhosis compensated+ or-Normal or elevatedTreat with oral agents, not PEG IFN Cirrhosisdecompensated+ or -Normal or elevatedTreat with oral agents, not PEG IFN; refer for liver transplantationHBeAg-negativeClinically inactive<104 or 105hNormal (2 x ULN)bInactive carrier; treatment not necessary Chronic hepatitis104 or 105hNormalConsider liver biopsy; treat if biopsy abnormal Chronic hepatitis104 or 105h (>2 x ULN)ElevratedTreat Cirrhosis compensated+ or -Elevated or normalTreat with oral agents, not PEG IFN (some authorites recommend either following or treating for HBV DNA < 104 copies/mL)Treat with oral agents, not PEG IFN (some authorities would follow without therapy for undetectable HBV DNA; refer for liver transplantation) Cirrhosisdecompensated+ or -Elevated or normal
Serial monitoring
Lamivudine therapy
Lamivudine therapy along with pulsed IFN therapy
IFN alone
Hepatitis