Treatment of Chronic Hepatitis B in HBsAg-Positive, HBeAg-Negative Infection Without Cirrhosis — Indeterminate Phase

This protocol applies to adults with chronic HBV infection who are HBsAg-positive and HBeAg-negative, have no cirrhosis, and fall in the indeterminate phase — a subset defined by detectable HBV DNA (≥ 2,000 IU/mL) alongside an ALT that remains below twice the upper limit of normal.

Clinical scenario

Adults who are HBsAg-positive and HBeAg-negative, without cirrhosis, in the indeterminate phase with HBV DNA ≥ 2,000 IU/mL and ALT < 2× ULN occupy an ambiguous zone where standard thresholds for treatment do not clearly apply. This makes the risk-benefit assessment particularly individualized.

Treatment approach

Current guidance suggests considering oral antiviral therapy using a nucleos(t)ide analogue, arrived at through a shared decision-making process that weighs the individual's risks and benefits. Whether to treat is reassessed at each follow-up visit if therapy has not yet been initiated.

Full regimen details, agent selection, and follow-up criteria are available in the structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

Population: Persons who are HBsAg-positive, HBeAg-negative without cirrhosis in indeterminate phase
In adults with HBsAg-positive, HBeAg-negative chronic HBV infection without cirrhosis and in the indeterminate phase, AASLD suggests antiviral therapy using a shared decision-making approach by assessing risks and benefits and to reevaluate that decision at each follow-up visit if treatment has not been initiated.

DOI: 10.1097/HEP.0000000000001549

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