Current and novel modalities for management of chronic hepatitis B infection

Table 1 Current therapy regimens for chronic hepatitis B viral infection as recommended by the American Association for the Study of Liver Diseases, 2023[68]

For adult patients	Treatment
Immune-active CHB (HBeAg negative or positive)	Antiviral therapy as PEG-IFN, tenofovir, or entecavir to decrease the risk of liver complications
Immune-tolerant CHB	Against antiviral therapy. Continuous monitoring of ALT levels at least every 6 mo for potential transition to immune-active or inactive CHB
Immune-active CHB HBeAg-negative	Indefinite antiviral therapy, unless there is a strong indication for treatment withdrawal
Compensated cirrhosis with low levels of viremia (< 2000 IU/mL)	Antiviral therapy to reduce the risk of decompensation, regardless of ALT level
Decompensated cirrhosis with positive HBsAg	Indefinite antiviral therapy, irrespective of the level of HBV DNA, ALT, or HBeAg status to decrease risk of worsening the condition
HBeAg-positive CHB without cirrhosis seroconvert to anti-HBe on NA therapy	Discontinue NAs after a period of treatment consolidation
HBeAg-positive CHB with cirrhosis seroconvert to anti-HBe on therapy	Indefinite antiviral therapy unless there is a strong indication for treatment withdrawal
For children (2 to < than 18 years)	Treatment
HBeAg positive with elevated ALT and HBV DNA levels	Antiviral therapy (IFN-α, PEG-IFN, and NAs) aiming for achieving sustained HBeAg seroconversion. PEG-IFN-α is recommended for use compared to NAs due to absence of viral resistance and finite duration of treatment
HBeAg-positive with persistently normal ALT, regardless of HBV DNA level	Against antiviral therapy

ALT: Alanine aminotransferase; anti-HBe: Antibody to hepatitis B e antigen; CHB: Chronic hepatitis B viral infection; HBeAg: Hepatitis B e antigen; HBsAg: Hepatitis B surface antigen; HBV: Hepatitis B virus; IFN-α: Interferon-alpha; NAs: Nucleos(t)ide analogues; PEG-IFN: Pegylated interferon; PEG-IFN-α: Pegylated-interferon-alpha.