16. What are the AASLD Practice Guidelines for treatment of chronic hepatitis B?

General management and counseling- this comes from Anna Lok at the University of Michigan and Brian McMahon who’s in Alaska and they’ve published a guideline that was just updated a couple of months ago and what they recommend are some common sense things. These are not evidence based, we can’t prove you ought to do this, but it just makes good sense to physicians. You ought to see carriers on a regular basis, and we think every six months is a reasonable interval for follow-up. The tests that we do routinely are the liver enzymes, the ALT and AST, alpha fetoprotein, and imaging. If the patient is an inactive carrier, that’s all we do. If the enzymes increase, then we have to re-evaluate what’s going on, something has changed. If they have chronic hepatitis B though and the ALT is elevated, then we follow with a CBC. Now why a complete blood count? That’s the hemoglobin, hematocrit, white count and platelets count. Well because we know that if you’re developing scar tissue in the liver, fibrosis, that’s going to make your spleen become more active and that’s going to lower your platelets count. So we get concerned if we see a gradually falling platelets count. In our world of hepatology, in liver practices, we call the platelets count, a poor man’s liver biopsy. Because if the platelets count falls, we know there is developing hepatic fibrosis. We monitor that, as well as the liver function tests and we measure regularly the e-antigen and e-antibody.