Practical approach in hepatitis B e antigen-negative individuals to identify treatment candidates

Table 1 Differences and similarities in American Association for the Study of Liver Disease, American Association for the Study of Liver Disease and European Association for the Study of the Liver guidelines on hepatitis B s antigen-negative treatment

	AASLD (2009)	APASL (2012)	EASL (2012)
Treatment candidacy
HBV DNA (IU/mL)	≥ 20000	≥ 2000	> 20000
ALT	≥ 2 × ULN	≥ 2 × ULN	≥ 2 × ULN
Other criteria			Treat if, HBV DNA > 2000, ALT > ULN and moderate to severe inflammation on liver biopsy and/or at least moderate fibrosis.
Liver biopsy (or noninvasive markers of fibrosis) to consider if
HBV DNA (IU/mL)	2000-20000	> 2000	> 2000
ALT	1-2 × ULN	1-2 × ULN	> ULN
Other criteria		≥ 40 yr old
First-line treatment
	PEG-IFN or Entecavir or Tenofovir	PEG-IFN or Entecavir or Tenofovir	PEG-IFN or Entecavir or Tenofovir
Duration of treatment
IFN	12 mo	12 mo	12 mo
Oral	> 1 yr	Unknown/long-term	Unknown/long-term
Stopping treatment strategy for NA
	Until HBsAg clearance	Until HBsAg clearance, may consider stopping if treated for at least 2 yr with undetectable HBV DNA on three separate occasions 6 mo apart.	Until HBsAg clearance.

APASL: Asian Pacific Association for the Study of the Liver; EASL: European Association for the Study of the Liver; AASLD: American Association for the Study of Liver Disease; ULN: Upper limit normal; NA: Nucleos(t)ides analogs; IFN: Interferon; HBsAg: Hepatitis B s antigen; HBV: Hepatitis B virus.