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Copyright ©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. Oct 7, 2014; 20(37): 13293-13305
Published online Oct 7, 2014. doi: 10.3748/wjg.v20.i37.13293
Table 1 Indications for treatment and recommended strategy for chronic hepatitis B
AASLD 2009EASL 2012APASL 2012
HBeAg positive hepatitisIndications for treatmentHBV DNA > 20000 IU/mL and ALT > 2 × ULNHBV DNA > 2000 IU/mL and ALT > ULNHBV DNA > 20000 IU/mL and ALT > 2 × ULN
Biopsy recommended1HBV DNA >20000 IU/mL and ALT 1-2 × UNL especially if age > 40 yr or family history of HCCHBV DNA > 2000 IU/mL and Age > 30 yr or family history of HCCHBV DNA > 20000 IU/mL or high normal or minimally raised ALT and age > 40 yr
Preferred drugs for naïve patientsPEG-IFN, ETV, TDFPEG-IFN, ETV, TDFIFN-based therapy, ETV, TDF
HBeAg negative hepatitisIndications for treatmentHBV DNA >20000 IU/mL2 and ALT > 2 × ULNHBV DNA > 2000 IU/mL and ALT > ULNHBV DNA > 2000 IU/mL and ALT > 2 × ULN
Biopsy recommended1HBV DNA >2000 IU/mL and ALT 1- > 2 × UNLUnmentionedHBV DNA > 2000 IU/mL or high normal or minimally raised ALT and age > 40 yr
Preferred drugs for naïve patientsPEG-IFN, ETV, TDFPEG-IFN, ETV, TDFIFN-based therapy, ETV, TDF
Liver cirrhosisIndication for treatmentCompensated: HBV DNA >2000 IU/mL; consider treating HBV < 2000 IU/mL if ALT > UNL Decompensated: any detectable HBV DNAAny detectable HBV DNACompensated: HBV DNA > 2000 IU/mL Decompensated: any detectable HBV DNA
Preferred drugs for naïve patientsCombination of LAM (or LDT) and ADV, ETV, TDFCompensated: PEG-IFN, ETV, TDF Decompensated: ETV, TDFETV, TDF (consider also IFN-based therapy if compensated LC and ALT < 5 × UNL)
1Consider treatment if moderate to severe inflammation or significant fibrosis is shown on liver biopsy; noninvasive methods may be useful in EASL and APASL guidelines;
2Treatment may be considered in patients with HBV DNA 2000-20000 IU/mL, particularly if they are older or have cirrhosis.AASLD: The American Association for the Study of the Liver Diseases; EASL: European Association for the Study of the Liver; APASL: The Asian Pacific Association for the Study of the Liver; ULN: Upper limit of normal; PEG-IFN: Pegylated interferon; ETV: Entecavir; TDF: Tenofovir; IFN: Interferon; LAM: Lamivudine; LDT: Telbivudine; ADV: Adefovir.