# HBV Follow-up Planning Tool

Choose common situations to generate an educational clinic-preparation checklist. This tool organizes questions only and does not decide treatment.

This tool is for health education and clinic preparation only. It does not provide personal diagnosis, treatment, stopping-medication, or testing-frequency decisions. Ask a qualified clinician to interpret your full history, tests, and local guidelines.

- Place HBV DNA, ALT/AST, liver function, ultrasound, AFP, elastography, and medication records in one follow-up checklist.
- Highlight topics to confirm with a clinician when cirrhosis, pregnancy, immunosuppression, or liver cancer family history is relevant.
- Flag symptoms that should not wait for routine follow-up.

## Inputs

- Have you been told you have chronic HBV or persistent HBsAg positivity? (known_chronic_hbv): yes=Yes; no=No / only an abnormal screening result; unknown=Not sure
- Are you currently taking HBV antiviral treatment? (on_antiviral_treatment): yes=Yes; no=No; unknown=Not sure
- Do you have cirrhosis, advanced fibrosis, or higher liver risk? (cirrhosis_or_advanced_fibrosis): yes=Yes; no=No; unknown=Not sure
- Are you pregnant, recently postpartum, planning pregnancy, or possibly pregnant? (pregnant_or_planning): yes=Yes; no=No; unknown=Not sure
- Will you soon receive chemotherapy, immunosuppression, biologics, or high-dose steroids? (immunosuppression_planned): yes=Yes; no=No; unknown=Not sure
- Do you have a family history of liver cancer? (family_history_liver_cancer): yes=Yes; no=No; unknown=Not sure
- Do you currently have jaundice, vomiting blood, black stools, major swelling, confusion, or similar warning symptoms? (concerning_symptoms): yes=Yes; no=No; unknown=Not sure
- About how long has it been since your last HBV-related follow-up? (follow_up_status): recent=Within 3-6 months; overdue=More than 6-12 months or forgotten; unknown=Not sure / no plan yet

## Educational follow-up checklist

### urgent_priority

- You selected warning symptoms: prioritize contacting a clinician, emergency department, or local emergency service instead of waiting for routine follow-up.

### immunosuppression_priority

- Before chemotherapy, immunosuppression, or biologics, confirm HBsAg, anti-HBc, anti-HBs, HBV DNA, and a prevention or monitoring plan.

### pregnancy_priority

- During pregnancy, postpartum, or pregnancy planning, bring HBV DNA, ALT, and perinatal prevention questions to obstetrics, pediatrics, and liver/infectious disease care.

### cirrhosis_priority

- With cirrhosis or advanced fibrosis, follow-up should cover antivirals, liver cancer surveillance, varices/ascites/encephalopathy risk, and medication safety.

### overdue_priority

- If follow-up is overdue, schedule liver, infectious disease, or gastroenterology care to rebuild a basic monitoring rhythm.

### baseline_priority

- Organize existing reports into a timeline and ask your clinician to confirm your next tests and date.

### baseline_checks

- HBV serology: HBsAg, anti-HBs, anti-HBc, and when relevant HBeAg/anti-HBe.
- Virus and inflammation: HBV DNA and ALT/AST.
- Liver function and safety: bilirubin, albumin, INR, platelets, creatinine/eGFR.
- Liver structure and fibrosis: ultrasound, elastography, or other clinician-recommended assessment.

### treatment_checks

- If on treatment, confirm whether HBV DNA is falling or staying low as expected, and discuss missed doses, side effects, and interactions.
- If taking tenofovir or at kidney/bone risk, ask whether creatinine, eGFR, phosphate, urine glucose/protein, or bone density should be checked.

### untreated_checks

- If not on treatment, ask which chronic HBV phase you are in and what changes would trigger treatment reassessment.

### hcc_checks

- Confirm whether you need liver cancer surveillance; many higher-risk people discuss ultrasound plus AFP, often about every 6 months.

### pregnancy_checks

- For pregnancy or planning, confirm HBV DNA, ALT, possible third-trimester prevention, infant vaccine/HBIG, and postpartum follow-up.

### immunosuppression_checks

- Before immunosuppression or cancer therapy, confirm whether preventive antivirals are needed and how often ALT and HBV DNA should be monitored.

### bring

- Past HBV reports or photos, including HBV DNA, ALT/AST, HBeAg/anti-HBe, and HBsAg.
- Ultrasound, AFP, elastography, CT/MRI, or cirrhosis-related reports.
- A list of current medicines, supplements, herbs, and over-the-counter drugs.
- Vaccine records, pregnancy/postpartum information, and immunosuppression or chemotherapy regimen names.

### baseline_questions

- What HBV infection or chronic HBV phase am I in now?
- What should I repeat next, and on what date?
- Which symptoms or result changes should make me contact you earlier?

### treatment_questions

- Is my current medicine appropriate for my kidney function, bone risk, pregnancy plans, and other medicines?
- If I miss doses, want to stop, face cost pressure, or need a medication change, who should I contact first?

### hcc_questions

- Do I need liver cancer surveillance? If yes, what tests and interval?

### special_questions

- Does this situation need a shared plan across liver/infectious disease, obstetrics, oncology, rheumatology, or another specialty?

### urgent_now

- Worsening jaundice, very dark urine, vomiting blood, black stools, confusion, major swelling, severe fatigue, or persistent vomiting should be assessed urgently.
- If you are on antivirals or recently stopped/missed doses and feel clearly unwell, contact a clinician promptly.

### urgent_watch

- Do not wait for routine follow-up if jaundice, dark urine, vomiting blood, black stools, confusion, fast abdominal swelling, low urine, or severe fatigue appears.

## Evidence sources

- [AASLD 2018 Hepatitis B Guidance on Immunosuppressive Therapy](https://openhbv.com/sources/aasld-2018-hepatitis-b-guidance-on-immunosuppressive-therapy.md?locale=en) — https://pmc.ncbi.nlm.nih.gov/articles/PMC5975958/
- [AASLD Practice Guidance on Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma](https://openhbv.com/sources/aasld-practice-guidance-on-prevention-diagnosis-and-treatment-of-hepatocellular-carcinoma.md?locale=en) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10663390/
- [CDC 2023 Hepatitis B Screening and Testing Recommendations](https://openhbv.com/sources/cdc-2023-hepatitis-b-screening-and-testing-recommendations.md?locale=en) — https://www.cdc.gov/mmwr/volumes/72/rr/rr7201a1.htm
- [Hepatitis B Online Choosing an Initial HBV Treatment Regimen](https://openhbv.com/sources/hepatitis-b-online-choosing-an-initial-hbv-treatment-regimen.md?locale=en) — https://www.hepatitisb.uw.edu/go/hbv/medications-used-to-treat-hbv
- [Hepatitis B Online Monitoring Persons On and Off HBV Therapy](https://openhbv.com/sources/hepatitis-b-online-monitoring-persons-on-and-off-hbv-therapy.md?locale=en) — https://www.hepatitisb.uw.edu/go/hbv/monitoring-persons-on-hbv-therapy
- [WHO 2024 Chronic Hepatitis B Guidelines](https://openhbv.com/sources/who-2024-chronic-hepatitis-b-guidelines.md?locale=en) — https://www.who.int/publications/i/item/9789240090903