Figure 4:

Proposed clinical algorithm for selecting HBV patients for antiviral therapy. In general, patients at risk for liver disease and needing therapy have persistently elevated ALT (normal, < 25 U/L in women, < 35 U/L in men) and elevated HBV DNA. However, normal ALT may not rule out liver disease risk and can fluctuate over time. Because of increased HCC risk with age, some experts are suggesting treating older patients (aged > 35 or 40 years) with high viral load regardless of ALT levels or fibrosis status. Any person with significant fibrosis regardless of ALT level should be considered for treatment, as per recommendation #16.

ALT = alanine aminotransferase; HBV = hepatitis B virus