Tuesday, September 25, 2018

How I Manage Low-Level Viremia in Patients Receiving HBV Therapy

How I Manage Low-Level Viremia in Patients Receiving HBV Therapy 
Robert S. Brown, Jr., MD, MP

An ongoing challenge is how to manage patients with HBV infection who have intermittent or persistent low-level viremia on treatment, but who do not meet the criteria for viral breakthrough. In my practice, I divide these patients into 2 groups: those with HBV that is detectable but not quantifiable (< 20 IU/mL) and those with HBV that is quantifiable (≥ 20 IU/mL).

Frequently, we see patients with test results reporting detectable but not quantifiable HBV levels, and I do not worry about these patients. In fact, many of these nonquantifiable readings are likely false positives.

However, I become concerned if the low-level viremia is quantifiable, even though this finding is much rarer in my practice. Although during the last 5 years the clinical community shifted from frequent use of combination therapy to monotherapy with entecavir or tenofovir even with intermittent low-level viremia, recent data indicate that quantifiable low-level viremia may be associated with worse outcomes, particularly in patients with cirrhosis....

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