Review Article

Hepatology International

, Volume 4, Issue 1, pp 386-395

Open Access This content is freely available online to anyone, anywhere at any time.

Chronic hepatitis B: whom to treat and for how long? Propositions, challenges, and future directions

  • Sang Hoon AhnAffiliated withDepartment of Internal Medicine, Yonsei University College of Medicine
  • , Henry L. Y. ChanAffiliated withDepartment of Medicine and Therapeutics, 9/F, Prince of Wales Hospital, The Chinese University of Hong Kong
  • , Pei-Jer ChenAffiliated withGraduate Institute of Clinical Medicine, National Taiwan University Hospital
  • , Jun ChengAffiliated withInstitute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
  • , Mahesh K. GoenkaAffiliated withInstitute of Gastroenterology and Endoscopy, Apollo Gleneagles Hospitals
  • , Jinlin HouAffiliated withHepatology Unit, Nanfang Hospital, Southern Medical University
  • , Seng Gee LimAffiliated withDepartment of Gastroenterology and Hepatology, National University Health System
  • , Masao OmataAffiliated withDepartment of Gastroenterology, University of Tokyo Email author 
  • , Teerha PiratvisuthAffiliated withNKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Prince of Songkla University
    • , Qing XieAffiliated withDepartment of Internal Medicine, Yonsei University College of MedicineDepartment of Infectious Disease, Ruijin Hospital, Shanghai Jiaotong University School of Medicine
    • , Hyung Joon YimAffiliated withDepartment of Internal Medicine, Yonsei University College of MedicineDivision of Gastroenterology, Department of Internal Medicine, Korea University Ansan Hospital
    • , Man-Fung YuenAffiliated withDepartment of Internal Medicine, Yonsei University College of MedicineDivision of Gastroenterology and Hepatology, The University of Hong Kong, Queen Mary Hospital
    • , the APPROACH Working Group


Recent guidelines of the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, and the Asian Pacific Association for the Study of the Liver 2008 update of the “Asian-Pacific consensus statement on the management of chronic hepatitis B” offer comprehensive recommendations for the general management of chronic hepatitis B (CHB). These recommendations highlight preferred approaches to the prevention, diagnosis, and treatment of CHB. Nonetheless, the results of recent studies have led to an improved understanding of the disease and a belief that current recommendations on specific therapeutic considerations, including CHB treatment initiation and cessation criteria, particularly in patient populations with special circumstances, can be improved. Twelve experts from the Asia-Pacific region formed the Asia-Pacific Panel Recommendations for the Optimal Management of Chronic Hepatitis B (APPROACH) Working Group to review, challenge, and assess relevant new data and inform future updates of CHB treatment guidelines. The significance of and controversy about reported findings were discussed and debated in an expert meeting of the Working Group in Beijing, China, in November 2008. This review paper attempts to identify areas requiring improved CHB management and provide suggestions for future guideline updates, with special emphasis on treatment initiation and duration.


Chronic hepatitis B (CHB) Hepatitis B virus (HBV) Nucleoside/nucleotide analog Interferon alfa HBV DNA ALT