What are the recommended follow-up protocols for patients diagnosed with chronic Hepatitis B?

Monitor ALT levels every 24 weeks in adults with HBeAg-positive disease in the immune-tolerant phase (defined by active viral replication and normal ALT levels) ¹.

Monitor ALT every 12 weeks on at least 3 consecutive occasions if there is an increase in ALT levels ¹.

In adults with inactive chronic hepatitis B (immune-control phase), monitor ALT and HBV DNA levels every 48 weeks ¹.

Review annually children and young people with HBeAg-negative disease who have normal ALT and no evidence of significant fibrosis, with HBV DNA less than 2000 IU/ml ¹.

Review every 12 weeks children and young people with HBeAg-negative disease who have abnormal ALT and HBV DNA greater than 2000 IU/ml ¹.

Perform 6-monthly surveillance for hepatocellular carcinoma (HCC) by hepatic ultrasound and alpha-fetoprotein testing in people with significant fibrosis or cirrhosis ¹.

In people without significant fibrosis or cirrhosis, consider 6-monthly HCC surveillance if they are over 40 years old, have a family history of HCC, and HBV DNA ≥20,000 IU/ml ¹.

Do not offer HCC surveillance in people younger than 40 years with HBV DNA less than 20,000 IU/ml and no significant fibrosis or cirrhosis ¹.

Follow-up after seroconversion involves monitoring HBeAg, anti-HBe, HBV DNA, and liver function at 4, 12, and 24 weeks, then every 6 months ¹.

Monitor HBsAg and anti-HBs annually in people with HBsAg seroconversion after antiviral treatment, and discharge those who are anti-HBs positive on 2 consecutive tests ¹.

Patients on antiviral therapy should have regular assessments of full blood count, liver and renal function, and HBV DNA levels at intervals specified in the guidelines, depending on the medication used and disease severity ¹.