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

Table 5 Management of chronic hepatitis B virus infection as per the World Health Organization[14]

Indications for anti-viral therapy in chronic hepatitis B
Evidence of significant fibrosis (≥ F2) based on an APRI score of > 0.5 or a transient elastographic value of > 7 kPa, regardless of DNA
Evidence of cirrhosis (F4) (based on clinical criteria (or an APRI score of > 1, or transient elastography value of > 12.5 kPab), regardless of HBV DNA or ALT levels
HBV DNA > 2000 IU/mL and an ALT level above the ULN on two occasions, 6 months apart
Presence of coinfections (HIV, HDV or HCV); family history of liver cancer or cirrhosis; immune suppression (such as long-term steroids, solid organ or stem cell transplant); comorbidities (such as diabetes or metabolic dysfunction–associated steatotic liver disease); or extrahepatic manifestations (such as glomerulonephritis or vasculitis), regardless of the APRI score or HBV DNA or ALT levels
In the absence of access to an HBV DNA assay persistently abnormal ALT levels (defined as 2 × ULN during a 6- to 12-month period), regardless of APRI score

HBV: Hepatitis B virus; ULN: Upper limit of normal; ALT: Alanine aminotransferase; APRI: Aspartate aminotransferase to platelet ratio; HIV: Human immunodeficiency virus; HDV: Hepatitis D virus; HCV: Hepatitis C virus.