JSH Guidelines for the Management of Hepatitis B Virus Infection

2014 Hepatology Research 44, Suppl S1 (1-58)

Indications for treatment
- who should we treat? Indications for liver biopsy Hepatic fibrosis can be evaluated via noninvasive alternatives to biopsy, such as serum fibrosis markers, imaging studies including CT and ultrasound, and liver stiffness measurement. Confirmation of hepatic fibrosis using any of these techniques is considered a treatment indication.
Note that the use of serum fibrosis markers alone is not sufficiently accurate for assessment of the degree of fibrosis.
Recommendations
- Treatment is indicated in patients with chronic hepatitis with ALT levels ≥31 U/L and HBV DNA levels ≥4 log copies/mL, regardless of HBeAg status.
- Even in those cases not meeting the above criteria, if ALT levels rise slowly or intermittently, or the patient is aged ≥40 with a high HBV DNA levels, platelet count

Pubmed : 24397839