# HBV Follow-up Planning Tool

URL: https://openhbv.bangbo.dev/tools/hbv-follow-up?locale=en
Canonical Markdown: https://openhbv.bangbo.dev/tools/hbv-follow-up.md?locale=en
Language: en

## Summary

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

This tool uses OpenHBV source records on chronic HBV monitoring, treatment safety, liver cancer surveillance, and immunosuppression.

## What It Helps Organize

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

## Output Sections

- priority: Near-term priorities
- next_checks: Checks to confirm with a clinician
- bring: Information to bring
- questions: Questions to ask
- urgent: Do not wait for routine follow-up

## Educational follow-up checklist

### Near-term priorities

- `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.

### Checks to confirm with a clinician

- `baseline_checks`: HBV serology: HBsAg, anti-HBs, anti-HBc, and when relevant HBeAg/anti-HBe.
- `baseline_checks`: Virus and inflammation: HBV DNA and ALT/AST.
- `baseline_checks`: Liver function and safety: bilirubin, albumin, INR, platelets, creatinine/eGFR.
- `baseline_checks`: 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.
- `treatment_checks`: 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.

### Information to bring

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

### Questions to ask

- `baseline_questions`: What HBV infection or chronic HBV phase am I in now?
- `baseline_questions`: What should I repeat next, and on what date?
- `baseline_questions`: 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?
- `treatment_questions`: 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?

### Do not wait for routine follow-up

- `urgent_now`: Worsening jaundice, very dark urine, vomiting blood, black stools, confusion, major swelling, severe fatigue, or persistent vomiting should be assessed urgently.
- `urgent_now`: 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.


## Disclaimer

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.

## Source Backing

- AASLD 2018 Hepatitis B Guidance on Immunosuppressive Therapy
  Source record: https://openhbv.bangbo.dev/sources/aasld-2018-hepatitis-b-guidance-on-immunosuppressive-therapy?locale=en
  Source Markdown: https://openhbv.bangbo.dev/sources/aasld-2018-hepatitis-b-guidance-on-immunosuppressive-therapy.md?locale=en
  Original URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC5975958/
  Organization: American Association for the Study of Liver Diseases
  Published: not listed
  Source updated: not listed
  Last checked: 2026-06-26
  Credibility note: 专业肝病学会指南
  Summary: AASLD 2018 乙肝指导中关于免疫抑制或细胞毒性治疗相关 HBV 再激活预防、筛查、预防性抗病毒治疗和监测的建议。
- AASLD Practice Guidance on Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma
  Source record: https://openhbv.bangbo.dev/sources/aasld-practice-guidance-on-prevention-diagnosis-and-treatment-of-hepatocellular-carcinoma?locale=en
  Source Markdown: https://openhbv.bangbo.dev/sources/aasld-practice-guidance-on-prevention-diagnosis-and-treatment-of-hepatocellular-carcinoma.md?locale=en
  Original URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC10663390/
  Organization: American Association for the Study of Liver Diseases
  Published: not listed
  Source updated: not listed
  Last checked: 2026-06-26
  Credibility note: 专业肝病学会指南
  Summary: AASLD 关于肝细胞癌预防、诊断和治疗的实践指导，包含高风险人群监测、超声联合 AFP、约每 6 个月监测和异常结果后进一步诊断评估等建议。
- CDC 2023 Hepatitis B Screening and Testing Recommendations
  Source record: https://openhbv.bangbo.dev/sources/cdc-2023-hepatitis-b-screening-and-testing-recommendations?locale=en
  Source Markdown: https://openhbv.bangbo.dev/sources/cdc-2023-hepatitis-b-screening-and-testing-recommendations.md?locale=en
  Original URL: https://www.cdc.gov/mmwr/volumes/72/rr/rr7201a1.htm
  Organization: Centers for Disease Control and Prevention
  Published: not listed
  Source updated: not listed
  Last checked: 2026-06-26
  Credibility note: 国家公共卫生机构
  Summary: CDC 2023 年乙肝筛查和检测建议，包含成人一次性三项筛查，以及接受或需要细胞毒性、免疫抑制或免疫调节治疗人群的检测建议。
- Hepatitis B Online Choosing an Initial HBV Treatment Regimen
  Source record: https://openhbv.bangbo.dev/sources/hepatitis-b-online-choosing-an-initial-hbv-treatment-regimen?locale=en
  Source Markdown: https://openhbv.bangbo.dev/sources/hepatitis-b-online-choosing-an-initial-hbv-treatment-regimen.md?locale=en
  Original URL: https://www.hepatitisb.uw.edu/go/hbv/medications-used-to-treat-hbv
  Organization: University of Washington Hepatitis B Online
  Published: not listed
  Source updated: not listed
  Last checked: 2026-06-26
  Credibility note: 大学医学教育资源
  Summary: 面向临床学习者的慢性乙肝初始治疗方案说明，比较恩替卡韦、TDF、TAF 等药物，并讨论肾功能、骨密度、妊娠和合并疾病等用药安全考虑。
- Hepatitis B Online Monitoring Persons On and Off HBV Therapy
  Source record: https://openhbv.bangbo.dev/sources/hepatitis-b-online-monitoring-persons-on-and-off-hbv-therapy?locale=en
  Source Markdown: https://openhbv.bangbo.dev/sources/hepatitis-b-online-monitoring-persons-on-and-off-hbv-therapy.md?locale=en
  Original URL: https://www.hepatitisb.uw.edu/go/hbv/monitoring-persons-on-hbv-therapy
  Organization: University of Washington Hepatitis B Online
  Published: not listed
  Source updated: not listed
  Last checked: 2026-06-26
  Credibility note: 大学医学教育资源
  Summary: 面向临床学习者的慢性乙肝治疗前后监测说明，涵盖 ALT、HBV DNA、HBeAg/HBsAg 和肝癌筛查等随访项目。
- WHO 2024 Chronic Hepatitis B Guidelines
  Source record: https://openhbv.bangbo.dev/sources/who-2024-chronic-hepatitis-b-guidelines?locale=en
  Source Markdown: https://openhbv.bangbo.dev/sources/who-2024-chronic-hepatitis-b-guidelines.md?locale=en
  Original URL: https://www.who.int/publications/i/item/9789240090903
  Organization: World Health Organization
  Published: not listed
  Source updated: not listed
  Last checked: 2026-06-26
  Credibility note: 权威公共卫生指南
  Summary: WHO 2024 年慢性乙肝预防、诊断、照护和治疗指南，覆盖检测、治疗、随访和公共卫生策略。