A naïve HBV 55-Y man presented with evidence of liver cirrhosis. PCR test was done and showed undetectable viremia. However, the PCR one year back showed 30 iu. Is there a rational to initiate anti-HBV therapy?
All world guidelines [EASL, AASLD, APASL] recommend antiviral therapy in cirrhotic patients irrespective of HBV viral load
How is HBe Ag, Anti HBe AG, HBs AG and Anti HBsAG?
ASAT and ALAT?
Yes, treat please. Liver cirrhosis here is the cornerstone of anti-viral therapy regardless of viral load as supported by guidelines EASL, AASLD
cirrhosis pt need to be started on anti viral against HBV to prevent further damage to liver and development of HCC
In cirrhotic patients NUCs should be started regardless of viral load or AST/ALT levels!
Few points to consider.
1. Confirm there is cirrhosis. U/S is highly senstive, it is operator dependent. A more objective is the Fibroscan Kpa. Or else, you can calculate the APRI score and get an idea.
2. If cirrhosis is confirmed, then there is a clear indication for treatment.
3. In cirrhotics, treatment is likely indefinite. Patient might raise this issue.
4. Pt also requires surveillance US for HCC.
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