Monitoring Monitor disease progression and treatment response in patients with chronic hepatitis B before, after, and on treatment The following should be monitored at least annually: alanine aminotransferase levels (and aspartate aminotransferase to calculate APRI), hepatitis B surface antigen, hepatitis B e antigen, and hepatitis B viral DNA levels (if hepatitis B viral DNA testing is available) Non-invasive tests (APRI score or FibroScan) to assess for the presence of cirrhosis in patients who do not have cirrhosis at baseline Patient adherence should be monitored regularly and at each follow-up visit if on treatment (strongly recommended, moderate quality evidence) More frequent monitoring Patients who have not yet met the criteria for antiviral therapy: the following patients need to be monitored for progression of their disease more frequently: intermittent elevations in alanine aminotransferase levels, fluctuating hepatitis B virus DNA levels fluctuating between 2000 IU/mL C 20 000 IU/mL (if hepatitis B virus DNA can be detected), and patients with HIV co-infection (conditional recommendation, low-quality evidence) Patients on treatment or after discontinuation of treatment: the following patients need more frequent treatment monitoring (first year of treatment, at least every 3 months): patients with more advanced disease (compensated or decompensated cirrhosis); first year of treatment, needing more frequent treatment monitoring (at least every 3 months) cirrhosis); first year of treatment, need to assess treatment response and patient adherence; those with concerns about adherence; HIV co-infection; treatment interruptors. (Conditional Recommendation, Very Low Quality Evidence) Monitoring Tenofovir and Entecavir Toxicity All patients should be tested for baseline renal function and assessed for baseline risk of renal impairment prior to initiating antiviral therapy. Renal function should be monitored annually in patients on long-term tenofovir or entecavir therapy; pediatric patients should also be monitored for growth and development. (Conditional Recommendation, Very Low Quality Evidence) Monitoring for the Presence of Hepatocellular Carcinoma Routine abdominal ultrasound and alpha-fetoprotein screening every 6 months is recommended for the following patients: those with cirrhosis, regardless of age and other risk factors (Strong Recommendation, Low Quality Evidence) those with a family history of hepatocellular carcinoma (Strong Recommendation, Low Quality Evidence) those aged 40 years or older (depending on local hepatocellular carcinoma incidence, a lower age may also be set), and those without a family history of hepatocellular carcinoma (Strong Recommendation, Low Quality Evidence). Lower age can be set), no clinical evidence of cirrhosis (or APRI score ≤ 2), but hepatitis B virus DNA level > 2000 IU/mL (if hepatitis B virus DNA can be detected). (Conditional Recommendation, Low Quality Evidence) Prevention Infant and Neonatal Hepatitis B Vaccination Current Recommendations for Infants and Neonates All infants should receive their first dose of hepatitis B vaccine as soon as possible after birth, preferably within 24 hours, and two to three subsequent doses. Antiviral treatment to prevent mother-to-child transmission Pregnant women who are infected with hepatitis B virus alone: indications for antiviral treatment are the same as for other adults, and tenofovir is recommended. Routine antiviral therapy for PMTCT is not recommended. Current recommendations for HIV-infected pregnant and lactating women Once-daily tenofovir + lamivudine (or entecavir) + efavirenz immobilized combination is recommended as first-line antiretroviral therapy for HIV-infected pregnant and lactating women, including pregnant women in the early stages of pregnancy and women of childbearing age. This recommendation applies to those on lifelong therapy as well as to those who start antiretroviral therapy and then discontinue it for the purpose of preventing mother-to-child transmission. (Strong recommendation, low-moderate quality evidence)