Chronic hepatitis B: Is it time for expanded antiviral treatment?

Table 2 Management of phases of chronic hepatitis B virus infection

	APASL[11]	EASL[10]	AASLD[8,9]	INASL[12]	KASL[13]
Monitor if	High DNA (> 2 × 106 IU/mL) and normal ALT (< 40 IU/L) if age < 30 years	High DNA (> 106 IU/mL) and normal ALT (< 40 IU/L)	High DNA (> 106 IU/mL) and normal ALT	High DNA (> 106 IU/mL) and normal ALT	High DNA (≥ 107 IU/mL) and normal ALT
Biopsy if	(1) > F2 fibrosis; (2) ALT > ULN; (3) > 35 years; and (4) Family history of cirrhosis/HCC				(1) > F2 fibrosis; (2) ALT > ULN; and (3) ≥ 30-40 years
Treat if	Biopsy shows significant inflammation or fibrosis		Biopsy shows significant inflammation or fibrosis	Extra-hepatic manifestation or, family history of cirrhosis with DNA > 2000 IU/mL	Biopsy shows significant inflammation or fibrosis
May treat if		(1) > 30 years with a family history of cirrhosis/HCC; and (2) Extra-hepatic manifestation	> 40 years and HBV DNA (> 106)	> 30 years

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 Diseases; INASL: Indian National Association for Study of the Liver; KASL: Korean Association for the Study of the Liver; HBV: Hepatitis B virus; ULN: Upper limit of normal; ALT: Alanine aminotransferase; HCC: Hepatocellular cancer.