Hepatitis B Management: Antivirals, Monitoring & Lifestyle

Chronic hepatitis B has no complete cure (HBsAg loss is rare), but effective suppression prevents cirrhosis, liver failure, and HCC.

1. Antiviral Therapy (Nucleos(t)ide Analogs — NUCs)

• First-line: Entecavir 0.5 mg daily, Tenofovir disoproxil fumarate (TDF) 300 mg daily, Tenofovir alafenamide (TAF) 25 mg daily.
• High barrier to resistance; long-term safety data robust.
• Second-line/legacy: Lamivudine, adefovir, telbivudine — higher resistance, not preferred.

2. Pegylated Interferon-α

• Finite course (48 weeks); immunomodulatory.
• Higher HBsAg loss rate (~3–7%) but significant side effects (flu-like, depression, cytopenias, thyroiditis).
• Selected patients: young, non-cirrhotic, genotype A/B, high ALT, low HBV DNA.

3. Monitoring on Treatment

• ALT, HBV DNA q3–6 months until undetectable, then q6–12 months
• Renal function (TDF/TAF), bone density (TDF)
• HCC surveillance: US ± AFP q6 months if cirrhotic or high-risk

4. Lifestyle Pillars

• Zero alcohol — no safe threshold
• Weight control — prevent NAFLD co-driver
• Balanced diet — Mediterranean pattern
• Avoid hepatotoxins — unregulated herbs, supplements
• Vaccinate contacts — HAV, HBV

5. Treatment Endpoints

• Functional cure: HBsAg loss + anti-HBs seroconversion (ideal, rare)
• Clinical cure: HBV DNA undetectable, ALT normal, no cirrhosis progression

Lifelong monitoring essential even after HBsAg loss — cccDNA persists, reactivation possible with immunosuppression.