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Viral Hepatitis and Liver Disease

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HBeAg-Negative Patients with Elevated ALT and Without Cirrhosis

for Health Care Providers

Monitoring Patients Not on Treatment - Hepatitis B

HBeAg-Negative, Elevated ALT, Without Cirrhosis

HBeAg-Negative Patients with Elevated ALT and Without Cirrhosis Flow Chart

* Cut off (upper limit of normal = ULN) of a normal ALT ≤ 35 U/L for males and ≤ 25 U/L for females is recommended to guide management decision

** Additionally exclude other causes of ALT elevation

*** Other factors in decision to treat HBeAg (-) with elevated ALT that is < 2x upper limit and HBV DNA ≥ 2,000 are Age > 40, family history of HCC, previous treatment history, presence of extrahepatic manifestations

Adapted from: Terrault NA, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560-1599. doi: 10.1002/hep.29800.