What are the WHO guidelines for when hepatitis B (HBV) (Hep B) should be monitored but not treated?

Updated: Jun 08, 2021
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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Antiviral therapy is not recommended  and can be deferred in individuals with all of the following, regardless of HBeAg status or age (strong recommendation):

  • No clinical evidence of cirrhosis (or based on APRI score ≤2 in adults)
  • Persistently normal ALT levels
  • Low levels of HBV DNA replication (HBV DNA < 2,000 IU/mL). (If HBV DNA testing is unavailable, treatment can be deferred in HBeAg-positive individuals aged 30 years or younger who have persistently abnormal ALT levels. (Conditional recommendation)]

All individuals with chronic hepatitis B—particularly those who do not meet the treat/do-not-treat criteria above—require continued monitoring to determine if antiviral therapy may be indicated in the future for prevention of liver disease progression. Such persons include noncirrhotic individuals aged 30 years or younger:

  • With HBV DNA levels above 20,000 IU/mL  but persistently normal ALT levels
  • Who are HBeAg-negative, with HBV DNA levels that fluctuate between 2,000 and 20,000 IU/mL or with intermittently abnormal ALT levels (If HBV DNA testing is unavailable, continue to monitor noncirrhotic individuals aged 30 years or younger who have persistently abnormal ALT levels, regardless of their HBeAg status.)

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