Clinical Guidelines

All children, teens and adults living with chronic hepatitis B infection should be monitored regularly since they are at increased risk for developing cirrhosis, liver failure, or liver cancer. Early detection of a serious liver problem increases one’s treatment options and improves long-term health outcomes.  In addition, all sexual partners and close family or household members should be tested for hepatitis B and vaccinated if needed.

Clinical Guidelines for Adults

The standard recommendation for care is to schedule visits with a liver specialist (or a care provider knowledgeable about hepatitis B) every six months, but this can be more or less depending on your medical situation. During these check-ups, the following usually occurs to monitor your health and your liver:

  • Physical exam
  • Blood tests for hepatitis B markers
  • Blood tests for liver enzymes (ALT/AST)
  • Blood tests for liver cancer screening (AFP)
  • Imaging studies of the liver (ultrasound, CT scans or FibroScan)

Screening for liver cancer (blood tests and imaging studies) should be included during these visits since the early detection of liver cancer will give you more treatment options and a better longterm prognosis.

Treatment decisions are based on formal guidelines developed by medical societies such as the American Association for the Study of Liver Diseases (AASLD), European Association for the Study of the Liver (EASL),  Asian Pacific Association for the Study of the Liver (APASL), and the World Health Organization. See below for care and treatment guidelines for chronic HBV.  

AASLD Guidelines for Treatment of Chronic Hepatitis B (November 2015) 

(APASL) Guidelines on the Management of Hepatitis B (November 2015)

WHO Guidelines for the Prevention, Care and Treatment of Persons with Chronic Hepatitis B Infection (March 2015)

EASL Clinical Practice Guidelines for Hepatitis B (2017) 

Hepatitis B Foundation Recommendations Screening and Monitoring Hepatitis B for Primary Care Providers (2010)

 

Clinical Guidelines for Children with Chronic Hepatitis B

In general, the clinical guidelines for children are the same as for adults - visits are usually scheduled every six months or once a year. Most children do not need drug treatment, but they still need to be monitored regularly to make sure they remain healthy and to detect any problems with their liver as soon as possible. Visits will include a physical exam, blood tests, and possibly an imaging study of the liver (ultrasound, FibroScan [Transient Elastography] or CT scan).

The Hepatitis B Foundation convened the first Pediatric HBV Workshop and invited the nation’s leading pediatric liver specialists to develop the first national recommendations for children living with hepatitis B to ensure that they receive the best care possible. These recommendations have been published in highly respected, peer-reviewed journals and provide expert guidance for the care of infected children.

Hepatitis B Foundation’s Clinical Guidelines for Pediatric HBV

HBF's Pediatric HBV Screening and Monitoring Recommendations
Published in Pediatrics in November 2009
Haber BA, Block JM, Jonas MM, Karpen SJ, London WT, McMahon BJ, Murray KF, Narkewicz MR, Rosenthal P, Schwarz KB. Recommendations for screening, monitoring, and referral of pediatric chronic hepatitis B. Pediatrics;124:e1007-13. (Nov. 2009)

HBF's Pediatric HBV Management and Treatment Recommendations
Published in Hepatology in October 2010
Jonas MM, Block JM, Haber BA, Karpen SJ, London WT, Murray KF, Narkewicz MR, Rosenthal P, Schwarz KB, and McMahon BJ (2010). Treatment of children with chronic hepatitis B virus infection in the United States: Patient selection and therapeutic options. Hepatology;52;2192-13. (Oct. 2010)


Additional Recommendations

Chronic Hepatitis B in Pregnancy: A Workshop Consensus on Screening, Evaluation, and Management, Part 1

Screening Recommendations for Hepatitis B

The role of primary care physician assistants in managing chronic hepatitis B

Chronic hepatitis B infection: A workshop consensus statement and algorithm

Internist Diagnosis and Management of Chronic Hepatitis B Virus Infection