A 26 year old man was observed to be positive for HBs Ag but negative for HBe Ag. The AST / ALT levls were observed to be within normal limits. The next step in management of this patient should be
Correct Answer: Serial monitoring
Description: Answer is A (Serial monitoring) HBe Ag Negative individuals with ALT Supper limit of normal do not require anti-viral treatment. Such individuals may be monitored sequentially with biochemical or virological markers. The patient in question is negative for HbeAg and has normal ALT levels. He is thus not a candidate for antiretroviral therapy. Such patients are best managed by sequential monitoring (biochemical and virological) over many months. even trigs have been approved for treatment of chronic Hepatitis B (Harrisons) Interferon a (and Pegylated Interferon) Lannivudine (oral) Adefovir (oral) Entecavir (oral) Dipivoxil (oral) Telbivudine Tenoir Recommendations for Treatment of Chronic Hepatitis B Based on practice guidelines of the American Association for the Study of Liver Diseases (AASLD). HBeAg status Clinical HBV DNA (IU/m1) ALT Recommendation HBeAg- reactive Mild or Inactive Liver disease >2 x104 2 x ULN No treatment; monitor. In patients >40, with family history of hepatocellular carcinoma, and/or ALT persistently at the high end of the twofold range, liver biopsy may help in decision to treat Chronic hepatitis >2 x 104 >2 x ULN Treat Cirrhosis compensated >2 x 103 < or > ULN Treat' with oral agents, not PEG IFN <2 x 10' >ULN Consider treatment Cirrhosis decompensated Detectable < or > ULN Treat' with oral agents", not PEG 1FN; refer for liver transplantation Undetectable < or > ULN Observe; refer for liver transplantation HBeAg- negative Mild or Inactive Liver disease < 2 x 103 ULN Inactive carrier; treatment not necessary Chronic hepatitis >103 l->2 x ULN Consider liver biopsy; treat' if biopsy shows moderate to severe inflammation or fibrosis Chronic hepatitis >104 >2 x ULN Treat"' Cirrhosis compensated >2 x 10 < or > ULN Treat' with oral agents, not PEG IFN <2 x 101 >ULN Consider treatment Cirrhosis decompensated Detectable < or > ULN Treat" with oral agents, not PEG IFN; refer for liver transplantation Undetectable <or > ULN Observe; refer for liver transplantation One of the potent oral drugs with a high barrier to resistance (entecavir or tenofovir) or PEG IFN can be used as first-line therapy. These oral agents, but not PEG IFN, should be used for interferon-refractory/intolerant and immunocompromised patients. PEG IFN is administered weekly by subcutaneous injection for a year; the oral agents are administered daily for at least a year and continued indefinitely or until at least 6 months after HBeAg seroconversion. Because the emergence of resistance can lead to loss of antiviral benefit and fuher deterioration in decompensated cirrhosis, a low-resistance regimen is recommended-entecavir or tenofovir monotherapy or combination therapy with the more resistance-prone lamivudine (or telbivudine) plus adefovir. Therapy should be instituted urgently. Because HBeAg seroconversion is not an option, the goal of therapy is to suppress HBV DNA and maintain a normal ALT. PEG IFN is administered by subcutaneous injection weekly for a year; caution is warranted in relying on a 6-month posttreatment interval to define a sustained response, because the majority of such responses are lost thereafter. Oral agents, entecavir or tenofovir, are administered daily, usually indefinitely or, until as very rarely occurs, virologic and biochemical responses are accompanied by HBsAg seroconversion.
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