Gastroenterology

PCP submission

I currently practice in a correctional facility.
I saw an incarcerated individual for the first time who is being treated for HBV since 6/ 2023 with entecavir.
he was successfully treated for HCV with Epclusa ( finished in 2/2024)
He is asx, has no SE with medication and his LFTS have normalized after HCV Tx on 5/24 labs ( previously elevated)
these are his prior HBV values:
8/2022 HBV log 6.3, quant 6800000,
2/2023 HBV DNA log 1.8 quant 68.
5/2024 HBV DNA log 1.4 , quant 25
hep Be Ag neg 5/24, was positive prior to that.

Would appreciate any recommendations for treatment for this individual and how to follow him.

Specialist response

Thank you for this consult. There are many ways to go about this, but the simplest is to continue therapy, even though the decline in DNA and transition from Hep E antigen positive to negative is favorable. Continue trending every 6 months twice, then drop to once per year – CBC, CMP, INR, Hep B surface antigen, DNA PCR, surface antibody. Once he is out of incarceration and more reliably followed up, cessation could be considered once the surface antigen is negative and DNA is undetectable for 2 values in a row, 6 months apart, but would not do this now because it may impose a greater follow up burden on you and the patient. (https://pubmed.ncbi.nlm.nih.gov/26563120/) The other alternative is to just keep him on therapy against Hep B and trend labs yearly. This may be the less intense and better option if he is incarcerate for a long time and with poor access to healthcare. Also make sure he has been screened for cirrhosis. The best method for this is fibroscan. RUQ US is also a second choice, less diagnostic. Cirrhosis mandates lifelong suppression. If you have any questions or further requests, please don’t hesitate to message back.