What are the WHO guidelines for when hepatitis B (HBV) (Hep B) should be treated?

Updated: Aug 01, 2018
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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Answer

Recommended: Treat 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):

  • 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 normal ALT levels alone, regardless of HBeAg status. [Conditional recommendation])

In individuals with HBV/human immunodeficiency virus (HIV) coinfection, initiate antiretrovial therapy (ART) in (1) all those with evidence of severe chronic liver disease, regardless of CD4 count, as well as (2) those with a CD4 count of 500 cells/mm3 or below, regardless of their liver disease stage. (Strong recommendation)


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