Considerations on expanding the indications for antiviral therapy from the perspective of staging of chronic hepatitis B virus infection

Abstract

Patients with chronic (hepatitis B virus,HBV) infection can be divided into immunotolerant, immunoclearance (HBeAg-positive, immune-active), immunocontrol (inactive), and reactivation (HBeAg-negative, immune-active) phases according to HBV serological markers, HBV DNA, alanine aminotransferase, and liver pathology results. Chronic HBV infection is considered indeterminate when the above four phasing criteria are not met. The Chinese "Guidelines" recommend antiviral B treatment for chronic HBV-infected patients with elevated alanine aminotransferase levels after excluding other potential causes. As a result, patients with chronic HBV infection in the immunoclearance and reactivation phases are included in the indication population for antiviral therapy, and the expanded indications are mainly for other infected individuals beyond these two phases: immunotolerant, immunocontrol, and indeterminate. Antiviral therapy may benefit individuals in an indeterminate phase, because they are at a relatively high risk of disease progression.