Management of chronic hepatitis B infection: Current treatment guidelines, challenges, and new developments

Figure 2 National Institute for Health and Care Excellence algorithm for initiation of treatment in chronic hepatitis B infection. Current indications for treatment are based on a combination of levels of serum hepatitis B virus (HBV) DNA, serum alanine transaminase (ALT), and the severity of liver disease. Specifically, patients with a transient elastography score ≥ 11 kPa are likely to have cirrhosis and confirmation by liver biopsy is not needed. Abnormal ALT, measured by two consecutive tests conducted 3 mo apart, is defined as ≥ 30 IU/mL in males, and ≥ 19 IU/mL in females.