Optimizing care of HBV infection and HBV-related HCC

Abstract

In patients with HBeAg-positive CHB without cirrhosis, both the American Association for the Study of Liver Diseases (AASLD) [8] and the Asian Pacific Association for the Study of the Liver (APASL) [9] suggest initiating treatment in patients with HBV DNA levels of > 20,0000 IU/mL with higher alanine aminotransferase (ALT) values of > 2× upper limit of normal (ULN). On the other hand, the European Association for the Study of the Liver (EASL) [10] suggests initiating treatment when the HBV DNA > 2000 IU/mL and ALT > ULN and/or at least moderate liver necroinflammation or fibrosis. In patients with HBeAg-negative CHB, AASLD, APASL, and EASL recommend initiating treatment when HBV DNA levels exceed 2000 IU/mL but vary concerning the thresholds for ALT. For patients with a histological examination showing moderate inflammation and fibrosis or significant fibrosis, the AASLD, APASL, and EASL also recommend starting treatment. [11] The WHO recommends that patients without cirrhosis above the age of 30 with persistently abnormal ALT and HBV DNA > 20,000 IU/mL are at risk of disease progression and should be considered for antiviral therapy. [12]