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Perspectives on current controversial issues in the management of chronic HBV infection

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Abstract

Clinical and basic research in the past decades has achieved consensus in the understanding of chronic hepatitis B virus (HBV) infection and the management of chronic hepatitis B and HBV-cirrhosis. However, debatable challenges to the existing consensus in the concept and/or definitions have emerged. These include (1). alanine aminotransferase upper limit of normal: traditional laboratory-defined vs fixed; (2). nomenclature for phases of chronic HBV infection: classical vs EASL proposal; (3). indication of antiviral therapy: to treat patients vs to treat HBV; (4). finite vs indefinite long-term antiviral therapy: A. finite therapy in HBV-cirrhosis; B. retreatment decision: biochemical markers vs HBsAg/ALT kinetics. The pros and cons of these controversial issues were reviewed, assessed, and discussed in depth based on relevant lines of scientific evidence, intended to clarify or solve these controversial issues.

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Fig. 1

(adapted from references [1, 2])

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

ALT:

Alanine aminotransferase

APASL:

Asian Pacific Association of the Study of Liver

CAP:

College of American Pathologists

CHB:

Chronic hepatitis B

EASL:

European Association for the Study of the Liver

ETV:

Entecavir

HBeAg:

Hepatitis B e antigen

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

IA:

Immune active phase

IC:

Inactive carrier

ICs:

Inactive carriers

IFN:

Interferon

IT:

Immune-tolerant phase

LC:

Liver cirrhosis

Nuc:

Nucleos(t)ide analog

PNALT:

Persistently normal ALT

TAF:

Tenofovir alafenamide

TDF:

Tenofovir disoproxil fumarate

ULN:

Upper limit of normal

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Acknowledgment

The author thanks Ms. Su-Chiung Chu for her secretary’s assistance and preparation of the manuscript and figures.

Funding

The author has been supported by grants from Chang Gung Medical Research Fund (CMRPG1K0101-3, CMRPG1K0111-3) and the Prosperous Foundation, Taipei, Taiwan.

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  1. Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199, Tung Hwa North Road, Taipei, 105, Taiwan

    Yun-Fan Liaw

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Liaw, YF. Perspectives on current controversial issues in the management of chronic HBV infection. J Gastroenterol 57, 828–837 (2022). https://doi.org/10.1007/s00535-022-01918-z

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