<prompt> A 26 years old man was found to be HBsAg positive but HBeAg negative and ALTAST normal, what will be the next step in his management?Serial monitoringLamivudine therapyLamivudine therapy along with pulsed IFN therapyIFN alone  <response>: ANSWER: A Serial monitoringREF: Harrisons 17th ed page 1957-1962The patient profile indicates that he is either in a non-reactive state or inactive carrier of chronic hepatitis; such patients are usually monitored sequentially.Markers for active replication - HbeAG, HBV- DNAAntiviral therapy is best indicated for patients with active replicationRecommendations for Treatment of Chronic Hepatitis B:HBeAgStatusClinicalHBV DNAcopiesmLALTRecommendationHBeAg-reactiveClinically inactive2 x ULNbTreat Cirrhosis compensated or-Normal or elevatedTreat with oral agents, not PEG IFN Cirrhosisdecompensated or -Normal or elevatedTreat with oral agents, not PEG IFN; refer for liver transplantationHBeAg-negativeClinically inactive104 or 105hNormal 2 x ULNbInactive carrier; treatment not necessary Chronic hepatitis104 or 105hNormalConsider liver biopsy; treat if biopsy abnormal Chronic hepatitis104 or 105h 2 x ULNElevratedTreat Cirrhosis compensated or -Elevated or normalTreat with oral agents, not PEG IFN some authorites recommend either following or treating for HBV DNA 104 copiesmLTreat with oral agents, not PEG IFN some authorities would follow without therapy for undetectable HBV DNA; refer for liver transplantation Cirrhosisdecompensated or -Elevated or normal 