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. Author manuscript; available in PMC: 2015 Oct 28.
Published in final edited form as: Am J Gastroenterol. 2014 Apr 15;109(6):867–875. doi: 10.1038/ajg.2014.72

Table A1. Summary of AASLD guidelines according to chronic hepatitis B phases.

Immune tolerant Immune active (e-antigen positive) Inactive carrier e-Antigen-negative chronic hepatitis: (core promoter/precore mutation) Possible e-antigen-negative hepatitisa
HBeAg status + + - - -
HBV DNA ≥20,000 IU ml−1 ≥20,000 IU ml−1 HBV DNA < 2,000 IU ml−1 HBV DNA > 20,000 IU ml−1 > 2,000 IU ml−1
ALT Normal (≤ 19 Ul−1 for women, ≤ 30 Ul−1 for men) ≥2×ULN (38 Ul−1 for women, 60 Ul−1 for men) Normal (≥ 19 Ul−1 for women, ≥ 30 Ul−1 for men) ≥2×ULN (38 UI−1 for women, 60 Ul−1 for men) ALT < 2×ULN (38 Ul−1 for women, 60 Ul−1 for men)
AASLD recommendation No treatment; check ALT q6 mo. If ALT becomes elevated, check HBV DNA and ALT q3 mo. Liver biopsy if persistent elevations in ALT or viral load or patient's age > 40 (distinguish immune tolerant vs. immune active). nitiate treatment if biopsy shows moderate/severe inflammation or significant fibrosis. Treat until 6 months after HBeAg + seroconversion. Liver biopsy before tx is optional. No treatment; check ALT q12 mo. If ALT becomes elevated, check HBV DNA and ALT q3 mo. Liver biopsy if persistent elevations in ALT or viral load (distinguish inactive carrier and e-antigen-negative chronic hepatitis B). Initiate treatment if biopsy shows moderate/severe inflammation or significant fibrosis Perform liver biopsy if persistent elevations in ALT or HBV DNA: distinguish between inactive carrier and e-antigen-negative CHB. Initiate treatment if biopsy shows moderate/severe inflammation or significant fibrosis
AASLD HCC Screening Guidelines for all phases
The following types of patients should be screened with ultrasound at least every 12 months. Alpha-fetoprotein can be used if ultrasound is not available.

  1. Any CHB patients over age 40 with ALT elevation or HBV DNA > 2000 IU ml−1.

  2. Men from endemic areas (presume vertical transmission) > 40 years and women from endemic areas > 50 years old. Africans should be screened if over the age of 20 years.

  3. Cirrhosis or advanced fibrosis.

  4. Family history of HCC.

AASLD, American Association for the Study of Liver Disease; ALT, alanine aminotransferase; HBV, hepatitis B virus; HCC, hepatitis C virus.

a

Phase defined by authors.

Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009;50:661–662.