Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Seven drugs have been approved for the treatment of chronic hepatitis B. Antiviral treatment has been shown to be effective in suppressing hepatitis B virus (HBV) replication, decreasing inflammation and fibrosis in the liver, and preventing progression of liver disease. However, current medications do not eradicate HBV; therefore, a key question is which patients need to start treatment and which patients can be monitored. Professional societies have developed guidelines to assist physicians in recognition, diagnosis and optimal management of patients with chronic hepatitis B. These guidelines suggest preferred approaches and physicians are expected to exercise clinical judgment to determine the most appropriate management based on the circumstances of the individual patient. This article reviews recommendations in hepatitis B guidelines and the basis for those recommendations and discuss what we do in our practice to illustrate factors that may influence decisions regarding hepatitis B management.