Table 1.

AASLD Recommendations for Treatment of Chronic Hepatitis B

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 End point of treatment = seroconversion from HbeAg to anti-Hbe Duration of therapy: • IFN-α: 16 weeks • LAM: minimum 1 year, continue for 3–6 months after HbeAg seroconversion • ADV: minimum 1 year IFN-α nonresponders/contraindications to IFN-α → LAM or ADV LAM resistance → ADV
-	+	>2 × ULN	IFN-α, LAM or ADV may be used as initial therapy, IFN-α or ADV is preferred End point of treatment = sustained normalization of ALT and undetectable HBV DNA by PCR assay Duration of therapy: • IFN-α: 1 year • LAM: > 1 year • ADV: > 1 year IFN-α nonresponders/contraindications to IFN-α → LAM or ADV LAM resistance → ADV
-	-	≤2 × ULN	No treatment required
±	+	Cirrhosis	Compensated: LAM or ADV Decompensated: LAM (or ADV); Refer for liver transplant. IFN-α contraindicated.
±	-	Cirrhosis	Compensated: Observe Decompensated: Refer for liver transplant

*HBV DNA > 10⁵. Abbreviations: HBeAg: hepatitis B e antigen; HBV: hepatitis B virus; ALT: alanine aminotransferase; ULN: upper limit of normal; IFN-α: interferon alfa; LAM: lamivudine; ADV: adefovir; PCR: polymerase chain reaction. Source: Lok AS, McMahon BJ. Chronic hepatitis B: update of recommendations. Hepatology 2004;39:857-61.