The most appropriate management is to perform no further treatment at this time. Hepatitis B virus (HBV) is diagnosed by serologic tests for HBV antigens and antibodies as well as direct HBV DNA assays. Inactive carriers of HBV have a normal alanine aminotransferase level and low levels of HBV DNA (generally less than 10,000 IU/mL) and are at low risk for progression of liver disease; therefore, initiation of medications to treat HBV in these patients is not justified. These patients remain at risk for reactivation of HBV, which may cause subsequent progression of liver disease. Monitoring for the development of chronic active HBV is therefore warranted. This patient's laboratory studies are consistent with HBV infection (positive hepatitis B surface antigen). His negative hepatitis B e antigen, low HBV DNA level, and normal serum alanine aminotransferase (ALT) level indicate that he is in the inactive carrier state. Hepatitis B treatment is not indicated; however, serum ALT levels should be monitored at 6-month intervals to detect potential transitions to other disease phases. Surveillance for hepatocellular carcinoma (HCC) is advised for patients with chronic HBV who have cirrhosis, a family history of HCC, or persistent elevation of ALT and HBV DNA levels. HCC surveillance is also advised in Asian men older than 40 years, Asian women older than 50 years, and African patients older than 20 years.

Treatment with pegylated interferon or entecavir should be considered if the patient has an elevated serum ALT level and HBV DNA level greater than 10,000 IU/mL. These features are not present in this patient, so treatment is not warranted at this time.

Treatment with lamivudine is seldom advised owing to the high rate of resistance with chronic administration.