1. Sustained suppression of HBV replication Decrease in serum HBV DNA to <10 5 copies/ml Seroconversion HBeAg to anti-HBe; HBsAg to anti-HBs 2. Remission of liver disease; Normalization of serum ALT levels Decreased necro-inflammation in liver 3.Improvement in clinical outcome; Decreased risks of developing cirrhosis, liver failure and HCC; 4.Increased survival

Patients who have Acute liver failure due to HBV ALT of >2 x UNL and or HBV DNA > 20,000 IU/ml Cirrhosis and clinical complications Cirrhosis or advanced fibrosis & HBV DNA in serum Reactivation of Chronic HBV after chemotherapy or immuno- suppression Infants born to women who are HBsAg-positive The immune-active phase who do not have advanced fibrosis or cirrhosis

Patients with Chronic hepatitis B in the immune-tolerant phase (with high levels of serum HBV DNA but normal serum ALT levels or little activity on liver biopsy) Patients in the inactive carrier or low replicative phase (with low levels of or no detectable HBV DNA in serum and normal serum ALT levels) Patients who have latent HBV infection (HBV DNA without HBsAg)

High baseline ALT level Low Baseline HBV DNA level Mild-to-moderate histological activity Mild to Moderate stage Liver Dysfunction Genotype of the HBV – (A>B>C>D) Baseline HBeAg positivity (wild virus) Genetic barrier to resistance - Lamivudine, Telbivudine and to a lesser degree, Adefovir

Persistently elevated HBV DNA Persistently elevated ALT (SGPT) HBV genotype C infection Male Gender, Older age Family history of HCC Co-infection with HCV or HIV or HDV

Interferon  2B Lamivudine Adefovir Peg Interferon Entecavir Telbivudine Tenofovir

HBeAg StatusHBV DNA IU/mlALT level x UNLRecommendation Positive> 20,000  2 times Do not treat Positive> 20,000> 2 timesPeg Inf, Adefovir, Entacavir Negative> 20,000> 2 timesPeg Inf, Adefovir, Entacavir Negative> 2,0001 to 2 timesLiver Bx. for Rx. decision Negative  2,000  1 time Observe

Obtain Baseline tests HBV DNA, ALT HBV Serology panel

Obtain Baseline tests HBV DNA, ALT HBV Serology panel

Endocrine Hypothyroidism Hyperthyroidism Dermatologic Rash, Dry skin, Pruritus Thinning of Hair Gastrointestinal Anorexia, Nausea, Weight loss Systemic Fever (low grade), Fatigue Myalgia and or Arthralgia Mood Disturbances Depression Irritability, Insomnia Hematologic Neutropenia, Anemia Thrombocytopenia

10 5 copies/ml (20,000 IU/ml)

Emtricitabine Clevudine (l-FMAU) Therapeutic vaccines