Deciding to Initiate Antiviral Treatment in Patients with Chronic Hepatitis B Virus Infection

Authors: John D. Scott, MD, MSc Chia C. Wang, MD, MS

Last updated: January 26, 2010

Learning Objectives

You are asked to see a 30-year-old Korean man with chronic hepatitis B virus infection. He tested hepatitis B surface antigen (HBsAg) positive more than 6 months ago. He has no other significant medical problems and his physical examination is normal, except for mild right upper quadrant tenderness. Additional laboratories demonstrate:

Hepatitis B e antigen (HBeAg): positive
Antibody to hepatitis B e antigen (anti-HBe): negative
HBV DNA: 200,000 IU/ml
Albumin 4.1 g/dL
Total bilirubin 1.0 mg/dL
International Normalized Ratio (INR) 1.0
Platelet count: 190,000 cells/ml

His serum alanine aminotransferase (ALT) has ranged between 90-110 U/L over the last six months.

Which of the following statements is true?

A Current treatment guidelines suggest that treatment is indicated for this patient.
B Liver biopsy is necessary before making a decision about initiating treatment
C If the patient has compensated cirrhosis, antiviral treatment would not be indicated because it could precipitate hepatic decompensation.
D The patient should not be treated for hepatitis B, but should be periodically tested for spontaneous HBeAg seroconversion (loss of HBeAg and development of anti-HBe).