Hepatitis B Follow Up

Monitoring

During Therapy  

During therapy, it is essential to monitor the patient’s ALT, HBeAg, anti-HBe, and/or HBV DNA at least every 3-6 months; and HBsAg every 6-12 months. Monitor the patient’s renal function (eg creatinine, phosphate) if Tenofovir, Entecavir, or Adefovir is used. Monitor for adverse effects (ie CBC, thyroid stimulating hormone) if Interferons are used. Monitor blood phosphorus levels and renal function every 6-12 months if Tenofovir disoproxil fumarate is used. Enhanced computed tomography (CT) and magnetic resonance imaging (MRI) may be performed for early detection of HCC, abdominal ultrasound and AFP every 6 months for cirrhosis-free patients, and every 3 months for patients with cirrhosis, during treatment with nucleos(t)ide analogue therapy.

End of Therapy  

At the end of therapy, induction of long-term viral suppression is the main endpoint of treatment. It is essential to monitor ALT and HBV markers (including HBV DNA) to detect relapse every 3-6 months for the first year then every 6-12 months. For patients with cirrhosis, the patient may be monitored monthly for the first 6 months then every 3 months, or every 6 months in patients who responded to therapy. Further monitoring of HBV DNA every 3-6 months in nonresponders is recommended to recognize delayed response and to plan retreatment if required. Monitor for HCC in high-risk patients every 6-12 months using ultrasound and alpha-fetoprotein. Enhanced CT scan and MRI may be performed for early detection.

Viral Resistance

Testing for viral resistance may be done in patients who have undergone treatment, those with persistent viremia despite nucleos(t)ide analogue therapy, or those who had a virological breakthrough (a 10-fold increase from nadir in serum HBV DNA during therapy after an initial virological response) while on therapy.

Chronic Hepatitis B Patients who are Not Treated but Need Continuous Monitoring

For chronic hepatitis B patients who are not treated but need continuous monitoring, monitor ALT every 3 months for the first year, then every 6-12 months thereafter. HBV DNA testing should be done if ALT and AST levels are elevated, and the interval for ALT monitoring should be reduced. This includes patients age <30 years without cirrhosis, with persistently normal alanine transaminase (PNALT), hepatitis B virus DNA >20,000 IU/mL, and HBeAg-negative patients age <30 years without cirrhosis, intermittently abnormal ALT levels, and HBV DNA between 2,000 and 20,000 IU/mL. 

Complications

Chronic hepatitis B virus infection increases the patient's risk for liver failure, portal hypertension, liver cirrhosis, and HCC.