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Viral Hepatitis and Liver Disease

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HBeAg-Positive Patients with Elevated ALT and Without Cirrhosis

for Health Care Providers

Monitoring Patients Not on Treatment - Hepatitis B

HBeAg-Positive, Elevated ALT, Without Cirrhosis

HBeAg-Positive 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 monitor HBeAg every 6-12 mo

*** Other factors in decision to treat elevated ALT that is < 2x upper limit and HBV DNA is < 20,000: Age > 40, family history of HCC, previous treatment history, presence of extrahepatic manifestations, presence of cirrhosis

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.

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