Table 3:

Comparison of Recommendations for Treatment and Monitoring of Chronic Hepatitis B

	WHO	AASLD
Who to treat	• All compensated and decompensated cirrhotics  • All adults above age of 30 years with chronic HBV without clinical evidence of cirrhosis (based on APRI score ≤2 and physical examination) but have persistently abnormal ALT levels and evidence of HBV DNA >20000 IU/ml (if available) regardless of HBeAg status.	• All compensated and decompensated cirrhotics  • HBeAg positive patients with HBV DNA >20,000 IU/ml and ALT > 2xULN  • HBeAg negative patients with HBV DNA >2,000 IU/ml and ALT > 2xULN
Criteria used for deciding treatment	• Age,  • ALT levels  • Fibrosis staging based on APRI score	• HBV DNA levels  • ALT level  • HBeAg status  • Fibrosis staging based on liver biopsy or non-invasive tests including vibration controlled transient elastography
Upper limit of normal for ALT	Laboratory defined upper limit of normal	• Men ALT of 35 U/L  • Women ALT of 25 U/L
What drugs to treat with	• Tenofovir disoproxil fumarate  • Entecavir	• Tenofovir disoproxil fumarate  • Entecavir  • Tenofovir alafenamide  • Peg-interferon alfa-2a
When to stop treatment	• Cirrhosis – continue treatment indefinitely  • No cirrhosis-Consider discontinuing NUCs if there is HBeAg seroconversion or HBsAg loss and treatment consolidation for at least 12 months	• Cirrhosis – continue treatment indefinitely  • No cirrhosis-Consider discontinuing NUCs if there is HBeAg seroconversion or HBsAg loss and treatment consolidation for at least 12 months
Treatment failure	• Lamivudine, Adefovir, Telbivudine and Entecavir resistance – switch to Tenofovir	Lamivudine, Adefovir, Telbivudine and Entecavir resistance – switch to Tenofovir/Tenofovir alafenamide/add Tenofovir/ tenofovir alafenamide to ongoing therapy Tenofovir resistance-switch/add Entecavir
Screening for hepatocellular carcinoma	Ultrasound + AFP every 6 months	Ultrasound ± AFP every 6 months