When is treatment recommended by the WHO for chronic hepatitis B (HBV) (Hep B) infection?

Updated: Jun 08, 2021
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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The 2015 WHO guidelines for the prevention, care, and treatment of persons with chronic hepatitis B infection indicates treatment priority for individuals of all ages who have chronic hepatitis B infection and clinical evidence of compensated/decompensated cirrhosis or cirrhosis based on APRI [aspartate aminotransferase (AST)-to-platelet ratio index] score >2 in adults), regardless of their levels of ALT or HBV DNA, or their HBeAg status. [55] (Strong recommendation)

Treatment is recommended for adults with chronic hepatitis B infection without clinical evidence of cirrhosis (or based on APRI score ≤2 in adults), but who have all of the following features , and regardless of HBeAg status (strong recommendation) [55] :

  • Are older than 30 years (in particular)
  • Have persistently abnormal ALT levels
  • Have evidence of high-level HBV replication (HBV DNA >20,000 IU/mL). (If HBV DNA testing is unavailable, consider treatment based on persistently abnormal ALT levels alone, regardless of HBeAg status. [Conditional recommendation])

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