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©The Author(s) 2021.
World J Gastroenterol. Nov 21, 2021; 27(43): 7497-7508
Published online Nov 21, 2021. doi: 10.3748/wjg.v27.i43.7497
Published online Nov 21, 2021. doi: 10.3748/wjg.v27.i43.7497
Table 1 Summary of treatment criteria for chronic hepatitis B
HBeAg+; HBV DNA (IU/mL) | HBeAg+; ALT (IU/L) | HBeAg–; HBV DNA (IU/mL) | HBeAg–; ALT (IU/L) | Cirrhosis | |
EASL[15] | ≥ 2000 | > ULN and/or at least moderate liver necro-inflammation or fibrosis | ≥ 2000 | > × ULN or significant histological disease | HBV-DNA detectable |
≥ 20000 | > 2 × ULN or irrespective of fibrosis | ≥ 20,000 | > 2 × ULN irrespective of fibrosis | ||
APASL[16] | ≥ 20000 | > 2 × ULN or significant histological disease | ≥ 2000 | > 2 × ULN or significant histological disease | HBV-DNA detectable |
AASLD[17] | > 20000 | > 2 × ULN or significant histological disease | ≥ 2000 | > 2 × ULN or significant histological disease | HBV-DNA detectable |
JSG[18] | ≥ 2000 | > ULN | ≥ 2000 | > ULN | HBV-DNA detectable |
Table 2 Treatment indications for patients with hepatitis B e-antigen positive, alanine aminotransferase < upper limit of normal for chronic hepatitis B
Monitor criteria | Consideration for anti-viral therapy | |
EASL[15] | Normal ALT (< 40 IU/L) and high HBV DNA (≥ 2000 IU/mL) levels. Monitor ALT and HBV DNA levels every 3-6 mo | Age > 30 yr, family history of HCC or cirrhosis and extrahepatic manifestations. Consider liver biopsy or non-invasive test if: ALT level is elevated; excluding other causes |
APASL[16] | Normal ALT (< 40 IU/L) and high HBV DNA (≥ 20000 IU/mL) levels Monitor ALT and HBV DNA levels every 3 mo | Age > 35 yr, liver biopsy showing F2/A2, significant fibrosis by non-invasive tests, stiffness ≥ 8 kPa, persistently elevated ALT, family history of HCC/cirrhosis |
AASLD[17] | Normal ALT [< 35 IU/L (male), < 25 IU/L (female)] and high HBV DNA (≥ 20000 IU/mL) levels. Monitor ALT and HBV DNA levels every 3-6 mo | Liver biopsy or non-invasive test shows ≥ F2 or F3, persistently elevated ALT level; exclude other causes, especially age > 40 yr |
JSG[18] | Normal ALT (≤ 30 IU/L) level | Consider liver biopsy or non-invasive test if Age > 40 yr, high HBV DNA or platelet counts < 15 × 104/uL, family history of HCC |
Table 3 Treatment indications for patients in the hepatitis B e-antigen-negative immune-inactive phase
Monitor criteria | Consideration for anti-viral therapy | |
EASL[15] | Normal ALT (< 40 IU/L) and HBV DNA (< 2000 IU/mL) levels. Monitor ALT and HBV DNA levels (< 2000 IU/mL)every 6-12 mo, (≥ 2000 IU/mL)every 3-6 mo | Age > 30 yr, family history of HCC or cirrhosis and extrahepatic manifestations |
APASL[16] | Normal ALT (< 40 IU/L) and HBV DNA (< 2000 IU/mL) levels. Monitor ALT and HBV DNA levels every 3-6 mo | Age > 35 yr, liver biopsy showing F2 or A2, significant fibrosis by non-invasive tests, stiffness ≥ 8 kPa, persistently elevated ALT, family history of HCC/cirrhosis |
AASLD[17] | Normal ALT [< 35 IU/L (male), < 25 IU/L (female)] and HBV DNA (< 2000 IU/mL) levels. Monitor ALT and HBV DNA levels every 3 mo for 1 yr, then every 6 mo | Liver biopsy or non-invasive test shows ≥ F2 or F3, persistently elevated ALT level; exclude other causes, especially age > 40 yr |
JSG[18] | Normal ALT level (≤ 30 IU/L) and HBV DNA (< 2000 IU/mL) levels | Consider liver biopsy or non-invasive test if age > 40 yr, high HBV DNA or platelet counts < 15 × 104/uL, family history of HCC |
- Citation: Kawanaka M, Nishino K, Kawamoto H, Haruma K. Hepatitis B: Who should be treated?-managing patients with chronic hepatitis B during the immune-tolerant and immunoactive phases. World J Gastroenterol 2021; 27(43): 7497-7508
- URL: https://www.wjgnet.com/1007-9327/full/v27/i43/7497.htm
- DOI: https://dx.doi.org/10.3748/wjg.v27.i43.7497