Elaborate the indications for initiating antiviral therapy in a patient with chronic hepatitis B.
Antiviral therapy for chronic hepatitis B aims to suppress HBV replication, limit liver injury, and prevent cirrhosis, hepatic failure, or hepatocellular carcinoma (HCC). The decision to initiate treatment depends on HBeAg status, HBV DNA levels, liver enzyme activity, and fibrosis stage.
HBeAg-positive disease: Therapy is recommended when HBV DNA exceeds 20,000 IU/mL with elevated ALT, particularly when biopsy reveals moderate to severe inflammation or fibrosis. Patients with cirrhosis require treatment regardless of ALT or viral load.
HBeAg-negative disease: Therapy is indicated if HBV DNA is above 2,000 IU/mL and ALT is persistently raised, especially when histology confirms significant inflammation or fibrosis. Cirrhotic patients are treated regardless of HBV DNA or ALT levels.
Earlier treatment may be justified in individuals with family history of HCC or cirrhosis, or in those with extrahepatic manifestations. Ultimately, decisions balance viral replication with liver disease severity and risk of progression.
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Sakshi Negi
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