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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.