🟡 Chronic Hepatitis B Antiviral Treatment Indications
This tool judges whether a person with chronic HBV infection meets antiviral treatment indications using HBV DNA, ALT, cirrhosis, and risk factors.
Clinical takeaway
An HBV DNA–positive person with normal ALT still warrants treatment once any single risk factor (age > 30, family history, fibrosis, extrahepatic disease) is present. (original synthesis · not guideline verbatim)
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When to use
Use to triage to treatment, deferral with follow-up, or no treatment, applying the expanded risk-factor indications of the 2022 Chinese HBV guideline.
How it works
Cirrhosis → treat regardless of ALT/DNA. HBV DNA+ with ALT > ULN → treat. HBV DNA+ with normal ALT but family history/age > 30/G≥2 or F≥2/extrahepatic → treat. Otherwise follow up. Drugs: ETV/TDF/TAF.
Key points
- An HBV DNA–positive person with normal ALT still warrants treatment once any single risk factor (age > 30, family history, fibrosis, extrahepatic disease) is present. (original synthesis · not guideline verbatim)
- Cirrhosis is treated regardless of ALT, HBV DNA, or HBeAg, including decompensated DNA-negative disease.
- Immunosuppression/chemotherapy requires prophylactic antivirals to prevent reactivation even without active disease.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| HBV cirrhosis (compensated or decompensated) | Present |
|---|---|
| Serum HBV DNA | Positive (detectable) |
| ALT persistently > upper limit of normal (other causes excluded) | Yes |
| Age > 30 yr | Yes |
| Family history of HBV cirrhosis or hepatocellular carcinoma (HCC) | Present |
| Significant hepatic inflammation (G ≥ 2) or fibrosis (F ≥ 2) | Present |
| HBV-related extrahepatic manifestations (e.g. glomerulonephritis) | Present |
→Antiviral indicationAntiviral treatment recommended
- Basis for decision：HBV cirrhosis (compensated/decompensated) is treated regardless of ALT, HBV DNA, or HBeAg
- Recommended drugs：ETV (entecavir) / TDF (tenofovir disoproxil) / TAF (tenofovir alafenamide)
- Basis：Chinese Guideline for the Prevention and Treatment of Chronic Hepatitis B 2022
| HBV cirrhosis (compensated or decompensated) | Absent |
|---|---|
| Serum HBV DNA | Negative |
| ALT persistently > upper limit of normal (other causes excluded) | No/normal |
| Age > 30 yr | No |
| Family history of HBV cirrhosis or hepatocellular carcinoma (HCC) | Absent |
| Significant hepatic inflammation (G ≥ 2) or fibrosis (F ≥ 2) | Absent |
| HBV-related extrahepatic manifestations (e.g. glomerulonephritis) | Absent |
→Antiviral indicationGenerally not needed, follow-up monitoring
- Basis for decision：HBV DNA negative, no cirrhosis
- Recommendation：Periodic follow-up; prophylactic antiviral therapy is needed before chemotherapy/immunosuppression/B-cell monoclonal antibodies or hematopoietic stem-cell transplant
- Basis：Chinese Guideline for the Prevention and Treatment of Chronic Hepatitis B 2022
Frequently asked questions
- What is Chronic Hepatitis B Antiviral Treatment Indications?
- This tool judges whether a person with chronic HBV infection meets antiviral treatment indications using HBV DNA, ALT, cirrhosis, and risk factors.
- How is Chronic Hepatitis B Antiviral Treatment Indications calculated? What is the core formula?
- Cirrhosis → treat regardless of ALT/DNA. HBV DNA+ with ALT > ULN → treat. HBV DNA+ with normal ALT but family history/age > 30/G≥2 or F≥2/extrahepatic → treat. Otherwise follow up. Drugs: ETV/TDF/TAF.
- When is Chronic Hepatitis B Antiviral Treatment Indications used?
- Use to triage to treatment, deferral with follow-up, or no treatment, applying the expanded risk-factor indications of the 2022 Chinese HBV guideline.
- What are the key clinical points for Chronic Hepatitis B Antiviral Treatment Indications?
- An HBV DNA–positive person with normal ALT still warrants treatment once any single risk factor (age > 30, family history, fibrosis, extrahepatic disease) is present. (original synthesis · not guideline verbatim) Cirrhosis is treated regardless of ALT, HBV DNA, or HBeAg, including decompensated DNA-negative disease. Immunosuppression/chemotherapy requires prophylactic antivirals to prevent reactivation even without active disease.
- What are the limits and cautions when using Chronic Hepatitis B Antiviral Treatment Indications?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Chronic Hepatitis B Antiviral Treatment Indications calculated in practice? Can you show a worked example?
- Inputs: HBV cirrhosis (compensated or decompensated) Present, Serum HBV DNA Positive (detectable), ALT persistently > upper limit of normal (other causes excluded) Yes, Age > 30 yr Yes, Family history of HBV cirrhosis or hepatocellular carcinoma (HCC) Present, Significant hepatic inflammation (G ≥ 2) or fibrosis (F ≥ 2) Present, HBV-related extrahepatic manifestations (e.g. glomerulonephritis) Present → Result: Antiviral indication Antiviral treatment recommended（Basis for decision: HBV cirrhosis (compensated/decompensated) is treated regardless of ALT, HBV DNA, or HBeAg, Recommended drugs: ETV (entecavir) / TDF (tenofovir disoproxil) / TAF (tenofovir alafenamide), Basis: Chinese Guideline for the Prevention and Treatment of Chronic Hepatitis B 2022） Inputs: HBV cirrhosis (compensated or decompensated) Absent, Serum HBV DNA Negative, ALT persistently > upper limit of normal (other causes excluded) No/normal, Age > 30 yr No, Family history of HBV cirrhosis or hepatocellular carcinoma (HCC) Absent, Significant hepatic inflammation (G ≥ 2) or fibrosis (F ≥ 2) Absent, HBV-related extrahepatic manifestations (e.g. glomerulonephritis) Absent → Result: Antiviral indication Generally not needed, follow-up monitoring（Basis for decision: HBV DNA negative, no cirrhosis, Recommendation: Periodic follow-up; prophylactic antiviral therapy is needed before chemotherapy/immunosuppression/B-cell monoclonal antibodies or hematopoietic stem-cell transplant, Basis: Chinese Guideline for the Prevention and Treatment of Chronic Hepatitis B 2022）