Table 1.

American Association for the Study of Liver Disease recommendations for the treatment of chronic hepatitis B (modified from Ref. ⁷ by permission)

HBeAg	HBV DNA	ALT	Treatment strategy
+	+	≤ 2 × ULN	Low efficacy with current treatment
			Observe: consider treatment when ALT becomes elevated
+	+	> 2 × ULN	IFN-α, LAM, or ADV may be used as initial therapy
			Endpoint of treatment—seroconversion from HBeAg to anti-HBe
			Duration of therapy
			• IFN-α: 16 weeks
			• Lamivudine: minimum 1 year, continue for 3-6 months after HBeAg seroconversion
			• Adefovir: minimum 1 year
			IFN-α non-responders/contraindications to IFN-α→LAM or ADV
			LAM resistance→ADV
−	+	>2 × ULN	IFN-α, LAM or ADV may be used as initial therapy
			Endpoint of treatment—sustained normalization of ALT and undetectable HBV DNA by PCR assay
			Duration of therapy
			• IFN-α: 1 year
			• Lamivudine: > 1 year
			• Adefovir: > 1 year
			IFN-α non-responders/contraindications to IFN-α→LAM or ADV
			LAM resistance→ADV
−	−	≤2 × ULN	No treatment required
±	+	Cirrhosis	Compensated: LAM or ADV
			Decompensated: LAM (or ADV); coordinate treatment with transplant centre. IFN-α contraindicated
±	−	Cirrhosis	Compensated: Observe
			Decompensated: Refer for liver transplant

ULN=upper limit of normal; IFN-α=interferon alpha; LAM=lamivudine; ADV=adefovir; PCR, polymerase chain reaction; ALT=alanine aminotransferase