Update on hepatitis B virus infection

Table 1 Indications for treatment and recommended strategy for chronic hepatitis B

		AASLD 2009	EASL 2012	APASL 2012
HBeAg positive hepatitis	Indications for treatment	HBV DNA > 20000 IU/mL and ALT > 2 × ULN	HBV DNA > 2000 IU/mL and ALT > ULN	HBV DNA > 20000 IU/mL and ALT > 2 × ULN
	Biopsy recommended1	HBV DNA >20000 IU/mL and ALT 1-2 × UNL especially if age > 40 yr or family history of HCC	HBV DNA > 2000 IU/mL and Age > 30 yr or family history of HCC	HBV DNA > 20000 IU/mL or high normal or minimally raised ALT and age > 40 yr
	Preferred drugs for naïve patients	PEG-IFN, ETV, TDF	PEG-IFN, ETV, TDF	IFN-based therapy, ETV, TDF
HBeAg negative hepatitis	Indications for treatment	HBV DNA >20000 IU/mL2 and ALT > 2 × ULN	HBV DNA > 2000 IU/mL and ALT > ULN	HBV DNA > 2000 IU/mL and ALT > 2 × ULN
	Biopsy recommended1	HBV DNA >2000 IU/mL and ALT 1- > 2 × UNL	Unmentioned	HBV DNA > 2000 IU/mL or high normal or minimally raised ALT and age > 40 yr
	Preferred drugs for naïve patients	PEG-IFN, ETV, TDF	PEG-IFN, ETV, TDF	IFN-based therapy, ETV, TDF
Liver cirrhosis	Indication for treatment	Compensated: HBV DNA >2000 IU/mL; consider treating HBV < 2000 IU/mL if ALT > UNL Decompensated: any detectable HBV DNA	Any detectable HBV DNA	Compensated: HBV DNA > 2000 IU/mL Decompensated: any detectable HBV DNA
	Preferred drugs for naïve patients	Combination of LAM (or LDT) and ADV, ETV, TDF	Compensated: PEG-IFN, ETV, TDF Decompensated: ETV, TDF	ETV, 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.

Table 2 Recommended treatment for drug resistance

Resistance to	AASLD 2009	EASL 2012	APASL 2012
LAM	Add ADV or TDF Switch to Truvada1	Switch to TDF (add ADV if TDF is not available)	Add ADV Switch to TDF Switch to IFN-based therapy
LDT	Add ADV or TDF Switch to Truvada1	Switch to or add TDF (add ADV if TDF is not available)	Add ADV Switch to TDF
ADV	Add LAM Switch to Truvada1 Switch to or add ETV	Switch to ETV or TDF Switch to TDF and add a nucleoside analogue if the patient has been treated with LAM	Add LAM, LDT or ETV Switch to TDF Switch to ETV plus TDF, if the patient has been treated with LAM or LDT
ETV	Switch to TDF or Truvada1	Switch to or add TDF (add ADV if TDF is not available)	Add TDF or ADV
TDF	Unmentioned	Add ETV, LDT, LAM or emtricitabine Switch to ETV if the patient has not been treated with LAM in the past	Unmentioned
MDR	Unmentioned	Combination of a nucleoside and a nucleotide	Unmentioned

¹Truvada is a combination pill containing emtricitabine 200 mg and tenofovir 300 mg. LAM: Lamivudine; LDT: Telbivudine; ADV: Adefovir; ETV: Entecavir; TDF:Tenofovir; MDR: Multidrug resistance; IFN: Interferon.