13. Should the e-antigen be used to determine the success/end point of treatment?
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If you actually look at a lot of the Asian
patients who have been infected a long time, they are already
seroconverted to
e-antibody positive and e-antigen
negative, and their DNA level could still be very
high. When I was on the FDA committee for the
lamivudine approval hearing, I raised this point. For those with long-term
chronic infection, using the e-antibody seroconversion may not be the
best way to determine the endpoint of treatment, because a lot of
people will already have this conversion, and they are still at high
risk for liver cancer. For those with a recent infection, the
seroconversion as endpoint works better. I think that in general, using the e-antigen
conversion to assess the endpoint of treatment should be
re-examined.
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12. What are the guidelines for evaluating treatment among chronic carriers with elevated ALTs (liver enzyme levels)?
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14. How do you determine which treatment should be used, and for how long?
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