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Christine M. Kukka
HBV Project Manager;
If you have just been diagnosed with hepatitis B:
• Your doctor should get your medical history and conduct a complete physical examination.
• You should be tested for liver disease, ALT and AST levels, and also have a complete blood counts with platelets, liver (hepatic) panel and prothrombin time. This requires a blood sample.
• You should get a viral test for surface antigens and antibodies, “e” antigen and antibodies, and the core antibody (HBcAb). This requires a blood sample.
• Your HBV-DNA should be tested, which requires a blood sample.
• You should be tested for liver cancer with an alpha fetoprotein (AFP) test. This also is run on a blood sample.
• Many doctors recommend you get a baseline ultrasound on your liver. Additional ultrasounds may be recommended in the future if liver cancer is suspected.
• A liver biopsy to evaluate your grade and stage of liver disease is recommended if you have signs of liver damage and are a candidate for treatment.
If you have the “e” antigen (HBeAg), have HBV-DNA at 105 100,000) copies/mL or lower and have normal ALT levels:
• Have your ALT levels tested every three to six months.
• Have a viral test every year or more often to assess your surface and “e” antigen and antibody status.
• Have your HBV-DNA tested at least once a year.
• Have an AFP test for liver cancer once a year.
If you have the “e” antigen (HBeAg) or “e” antibody (HBeAb), have HBV-DNA at 105 (100,000) copies/mL or higher and have ALT levels up to twice the normal range:
• Have your ALT levels tested every one to three months.
• Have a viral test every year or more often to assess your surface and “e” antigen and antibody status.
• Have your HBV-DNA tested. If you have high ALTs and high HBV-DNA levels, even though you have the “e” antibody, you may have a strain of hepatitis B that does not produce the “e” antigen.
• Have an AFP test for liver cancer at least once a year.
If you have the “e” antigen (HBeAg), have HBV-DNA at 105 (100,000) copies/mL or higher, and have ALT levels more than twice the normal range over three to six months:
• Your doctor may recommend a liver biopsy before prescribing treatment.
• Your ALT levels should be tested every one to three months.
• Have a viral test every year or more often to assess your surface and “e” antigen/antibody status.
• Have your HBV-DNA tested regularly.
• Have an AFP test for liver cancer every six to 12 months.
If you have the “e” antibody (HBeAb), have undetectable HBV-DNA and normal ALT levels:
• Have your ALT levels checked every six to 12 months.
• Have a viral test once a year or more often to assess your surface and “e” antigen and antibody status.
• Have your HBV-DNA tested at least once a year.
• Have an AFP test for liver cancer once a year.
These recommendations are based in part on the American Association for the Study of Liver Diseases Practice Guidelines for Hepatitis B, issued October 2002.
If your doctor does not test you as frequently as these guidelines recommend, you may want to print out the AASLD practice guidelines for hepatitis B, found at: http://www.aasld.org/pdffiles/
chronichepatolendorse.pdf, and present them to your physician.
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