Key guideline recommendations for indication for antiviral treatment of HBV infection
| Belgian (Colle 2007) | Consider treatment: • HBeAg(+): HBV DNA >20,000 IU/mL + ALT >2x ULN (or moderate/severe hepatitis on biopsy) • HBeAg(–): HBV DNA ≥2,000 IU/mL and elevated ALT Consider biopsy: • Fluctuating or minimally elevated ALT (especially in those older than 35-40 years) |
| Turkish TASL (Akarca 2008) | Consider treatment: • HBV DNA >2,000 IU/mL + histological fibrosis >2 • HBV DNA >20,000 IU/mL + any histological finding + ALT >2x ULN |
| Dutch (Buster 2008) | Consider treatment: • HBeAg(+) and HBeAg(–): HBV DNA ≥20,000 IU/mL and ALT ≥2x ULN or active necrotic inflammation • HBeAg(–): HBV DNA ≥2000 to 20,000 IU/mL and ALT ≥2x ULN (and absence of any other cause of hepatitis) |
| German (Cornberg 2011) | Consider treatment: • BV DNA >2000 IU/mL + minimal inflammation/low fibrosis or ALT elevation |
| Italian (Carosi 2011) | Consider treatment: • HBeAg(+): HBV DNA >20,000 IU/mL + ALT > ULN and/or METAVIR ≥ F2 or Ishak ≥ S3 • HBeAg(-): HBV DNA >2,000 IU/mL + ALT > ULN and/or METAVIR ≥ F2 or Ishak ≥ S3 Consider biopsy: • When fibrosis is suspected by non-invasive evaluation |
| EASL (EASL 2012) | Consider treatment: • HBV DNA >2000 IU/mL + moderate to severe necroinflammation and/or ALT > ULN • HBV DNA >20,000 IU/mL, ALT >2x ULN without liver histology |
| Korean (KASL 2012) | Consider treatment: • HBeAg(+): HBV DNA >20,000 IU/mL + ALT >2x ULN or ALT 1-2x ULN and moderate-to-severe degree of inflammation or periportal fibrosis • HBeAg(–): HBV DNA >2000 IU/mL + ALT >2x ULN or ALT 1-2x ULN and moderate-to-severe degree of inflammation or periportal fibrosis |
| AASLD (Terrault 2015) | Consider treatment: • Normal ALT and HBV DNA >1,000,000 IU/mL, >40 years of age with liver biopsy showing significant necroinflammation or fibrosis • HBeAg(+): HBV DNA >20,000 IU/mL + ALT ≤2x ULN + biopsy shows moderate/severe inflammation or significant fibrosis • HBeAg(+): HBV DNA >20,000 IU/mL + ALT >2x ULN • HBeAg(–): HBV DNA >2,000 IU/mL + ALT >2x ULN • Liver cirrhosis and HBV DNA > 2,000 IU/mL Consider biopsy: • HBeAg(+): HBV DNA >20,000 IU/mL + ALT >2x ULN + compensated • HBeAg(+): HBV DNA >20,000 IU/mL + ALT 1-2x ULN + age >40 years or family history of HCC • HBeAg(–): HBV DNA >2000 to 20,000 IU/mL + ALT 1-2x ULN |
| WHO (2015) | Consider treatment: • HBeAg(+) + HBeAg (–): HBV DNA >20,000 IU/mL + persistently abnormal ALT • if HBV DNA measurement is unavailable: persistently abnormal ALT levels (regardless of HBeAg status) after exclusion of glucose tolerance, dyslipidaemia and fatty liver |
| APASL (Sarin 2016) | Consider treatment: • All patients: HBV DNA detectable + moderate to severe inflammation or significant fibrosis • HBeAg(+): HBV DNA >20,000 IU/mL + ALT >2x ULN • HBeAg(–): HBV DNA >2,000 IU/mL + ALT >2x ULN • Decompensated liver cirrhosis • Compensated liver cirrhosis + HBV DNA >2,000 IU/mL (regardless of ALT levels) |
Author Profile
Dr. D.Zeqiraj medical doctor at QKUK- Pristina, department of Infectious disease.