Table 1.
Indications for CHB Treatment According to International Guidelines
| Guidelines | HBeAg | HBV DNA | ALT | Liver Histology | Treatment Strategy |
|---|---|---|---|---|---|
| APASL | + | >20,000 IU/mL | >2 ULN | Treatment should be considered | |
| − | >2,000 IU/mL | >2 ULN | Treatment should be considered | ||
| AASLD | + | >20,000 IU/mL | >2 ULN | Moderate or severe hepatitis | Treatment should be considered* |
| − | >20,000 IU/mL | >2 ULN | Moderate or severe hepatitis | Treatment should be considered† | |
| +/− | >2,000 IU/mL | Compensated cirrhosis | Treatment should be considered | ||
| +/− | <2,000 IU/mL | Elevated | Compensated cirrhosis | Treatment should be considered | |
| EASL | +/− | >2,000 IU/mL | >ULN | Moderate to severe necroinflammation and/or fibrosis | Treatment should be considered‡ |
| +/− | Detectable | <ULN | Compensated or decompensated cirrhosis | Urgent antiviral therapy |
Abbreviations: APASL, Asian‐Pacific Association for the Study of the Liver; AASLD, American Association for the Study of Liver Diseases; EASL, European Association for the Study of the Liver (EASL); ULN, upper limit of normal.
Treatment should be delayed for 3 to 6 months in patients with compensated liver disease to determine whether spontaneous HBeAg seroconversion occurs, whereas patients with icteric ALT flares should be treated promptly. Treatment should be considered for patients with normal or minimally elevated ALT levels if there is moderate or severe necroinflammation or significant fibrosis on liver biopsy.
Treatment should also be considered for these patients if the HBV DNA levels are between 2,000‐20,000 IU/mL and/or ALT are borderline normal or minimally elevated in the presence of moderate‐to‐severe necroinflammation or significant fibrosis on liver histology.
In patients who fulfill the above criteria for HBV DNA and histological severity of liver disease, treatment may be initiated even if ALT levels are normal.