Chronic hepatitis B: Chronic necroinflammatory disease of the liver caused by persistent HBV infection
1. HBsAg positive _ 6 mo
2. Serum HBV DNA _ 105 copies/mL
3. Persistent or intermittent elevation of ALT/AST levels
4. Liver biopsy showing chronic hepatitis (necroinflammatoryscore _ 4)a
Chronic hepatitis B can be subdivided into:
HBeAg-positive chronic hepatitis B : HBeAg positive, anti-HBe negative
HBeAg-negative chronic hepatitis B : HBeAg negative, anti-HBe positiveb
Inactive HBsAg carrier state: Persistent HBV infection of the liver without significant ongoing necroinflammatory disease
1. HBsAg positive _ 6 mo
2. HBeAg negative, anti-HBe positive
3. Serum HBV DNA _ 105 copies/mL
4. Persistently normal ALT/AST levels
5. Liver biopsy showing absence of significant hepatitis (necroinflammatory score _ 4)a
Resolved hepatitis B : Previous HBV infection without further virological, biochemical,or histological evidence of active virus infection or disease
1. Previous known history of acute or chronic hepatitis B or the presence of anti-HBc _ anti-HBs
2. HBsAg negative
3. Undetectable serum HBV DNAc
4. Normal ALT levels
Acute exacerbation or flare of hepatitis B: Intermittent elevations of aminotransferase activity to more than 10 times the upper limit of normal and more than 2 times the baseline value
Reactivation of hepatitis B: Reappearance of active necroinflammatory disease of the liver in a person known to have the inactive HBsAg carrier state or resolved hepatitis B
HBeAg clearance: Loss of HBeAg in a person who was previously HBeAg positive
HBeAg seroconversion: Loss of HBeAg and detection of anti-HBe in a person who was previously HBeAg positive and anti-HBe negative, associated with a decrease in serum HBV DNA levels to _ 105 copies/mL
HBeAg reversion: Reappearance of HBeAg in a person who was previously HBeAg negative and anti-HBe positive
Evaluation of Patients With Chronic HBV Infection
1.Initial evaluation
*History and physical examination
*Laboratory tests to assess liver disease: complete blood cell count with platelets, hepatic panel,and prothrombin time
*Tests for HBV replication: HBeAg/anti-HBe, HBV DNA
*Tests to rule out other causes of liver disease: anti-HCV, anti-HDV
*Tests to screen for HCC: AFP and US in high-risk patients
*Liver biopsy to grade and stage liver disease: for patients who meet criteria for chronic hepatitis
2.Suggested follow-up for patients not considered for treatment
*HBeAg-positive chronic hepatitis B with HBV DNA _ 105 copies/mL and normal ALT level : ALT every 3 to 6 mo,consider liver biopsy and/or treatment when ALT levels become elevated, consider screening for HCC in relevant populations
*Inactive HBsAg carrier state : ALT every 6–12 mo If ALT levels become elevated, check serum HBV DNA and exclude other causes of disease,Consider screening for HCC in relevant populations
7 years ago