Table 4.
Comparison of treatment indicators for patients with liver cirrhosis
| KASL | AASLD | EASL | APASL | |
|---|---|---|---|---|
| Compensated cirrhosis | 1) Treat if HBV DNA level is ≥2,000 IU/mL, regardless of the ALT level | 1) Treat if HBV DNA is >2,000 IU/mL, regardless of the ALT level | 1) Treat for any detectable HBV DNA, regardless of the ALT levels, in patients with compensated or decompensated cirrhosis | 1) Treat if HBV DNA is >2,000 IU/mL, even if the ALT levels are normal |
| 1) Treat | ||||
| 2) Consider | 2) Treatment can be considered if HBV DNA is detectable but low (<2,000 IU/mL), regardless of the ALT level | 2) Treat patients with low level viremia (HBV DNA <2,000 IU/mL), regardless of the ALT level | 2) Treatment can be considered irrespective of HBV DNA and ALT levels | |
| Decompensated cirrhosis | 1) Treat with a NA if serum HBV DNA is detected, regardless of the ALT level | 1) Treat with antiviral therapy indefinitely, regardless of the HBV DNA level, HBeAg, or ALT level | 1) Immediately treat with a NA with high barrier to resistance, irrespective of the HBV replication level | 1) Immediately treat with a NA for patients with detectable HBV DNA |
| 1) Treat | 2) Consider liver transplantation | 2) Consider liver transplantation | 2) Assess for the possibility of liver transplantation | 2) Consider treatment for all patients with hepatic decompensation, irrespective of HBV DNA levels |
| 2), 3) Consider | 3) Consider liver transplantation | |||
| First-line agents* | Entecavir, tenofovir DF, tenofovir AF,† besifovir† | Entecavir, tenofovir DF, tenofovir AF† | Entecavir, tenofovir DF, tenofovir AF† | Entecavir, tenofovir DF |
KASL, Korean Association for the Study of the Liver; APASL, Asian-Pacific Association for the Study of the Liver; HBV, hepatitis B virus; ALT, alanine aminotransferase; NA, nucleos(t)ide analog; HBeAg, hepatitis B e antigen; tenofovir DF, tenofovir disoproxil fumarate; tenofovir AF, tenofovir alafenamide fumarate.
*
Peg-interferon can only be used, with caution, for compensated cirrhosis, but may not be preferred owing to safety concerns.
†
Insufficient data for decompensated cirrhosis.