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The Natural History and Treatment of Chronic Hepatitis B: A Critical Evaluation of Standard Treatment Criteria and End Points

Ching-Lung Lai, MD; and Man-Fung Yuen, MD, PhD
[+] Article and Author Information

From the University of Hong Kong, Hong Kong, China.


Potential Financial Conflicts of Interest: Grants received: C.L. Lai (Bristol-Myers Squibb).

Requests for Single Reprints: Ching-Lung Lai, MD, Department of Medicine, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China; e-mail, hrmelcl@hkucc.hku.hk.

Current Author Addresses: Drs. Lai and Yuen: University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.


Ann Intern Med. 2007;147(1):58-61. doi:10.7326/0003-4819-147-1-200707030-00010
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The definite indications for the treatment of chronic hepatitis B are serum hepatitis B virus (HBV) DNA levels greater than 105 copies/mL and alanine aminotransferase (ALT) levels more than 2 times the upper limit of normal. If cirrhosis is present, an HBV DNA level greater than 105 copies/mL is the sole criterion for treatment. Treatment end points include hepatitis B e antigen (HBeAg) seroconversion for HBeAg-positive patients, reduction of HBV DNA levels to less than 105 copies/mL, and normalization of ALT values. These guidelines may apply to patients who acquire the hepatitis B infection during adolescence or adulthood but are less suitable for most hepatitis B carriers, who are infected in early life. Cirrhosis complications, including hepatocellular carcinoma, often occur in this latter group despite HBeAg seroconversion, HBV DNA levels less than 104 copies/mL, or ALT levels between 0.5 and 2 times the upper limit of normal. Therefore, HBeAg seroconversion may not be an adequate end point for these patients; the ideal treatment end points are permanent suppression of HBV DNA to levels undetectable by polymerase chain reaction and reduction of ALT levels to less than 0.5 times the upper limit of normal.

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