Monitoring and Management of Patients on Therapy for Chronic Hepatitis B

Authors: John D. Scott, MD David H. Spach, MD

Last updated: December 10, 2009

A 38-year-old Vietnamese man with chronic hepatitis B infection comes to you for follow-up. His past laboratory studies show positive hepatitis B e antigen (HBeAg), negative hepatitis B e antibody (anti-HBe), HBV DNA level of 108 IU/ml, and an alanine aminotransferase (ALT) between 30 to 40 U/L over a period of 12 months. A liver biopsy shows grade 3 inflammation and stage 2 fibrosis. He is started on entecavir (Baraclude).

Which of the following statements is TRUE regarding recommendations from the American Association for the Study of Liver Diseases (AASLD) regarding monitoring and management of patients on therapy for chronic hepatitis B?

A For HBeAg-positive patients, monitoring for HBeAg seroconversion should occur only after the patient has achieved HBsAg seroconversion.
B After starting therapy, the patient should have his ALT and HBV DNA level next measured at the end of 1 year of therapy.
C As soon as the patient obtains an undetectable HBV DNA level, it is advisable for him to stop therapy.
D If the patient’s HBV DNA level declines by 1 log10 after 6 months of therapy, the response is termed a primary non-response.