Table 2:

Treatment recommendations by various international organizations for patients positive for hepatitis B e-antigen

Recommendation	AASLD6 2018 (United States)^*	EASL7 2017 (Europe)^†	CASL3 2018 (Canada)^*	APASL5 201 (Asia)^†	WHO11 2015^‡
Treatment definitely recommended	ALT level > 2× ULN and HBV DNA level > 20 000 IU/mL	ALT level > 2× ULN and HBV DNA level > 20 000 IU/mL ALT level > ULN and HBV DNA level > 2000 IU/mL and/or moderate/severe inflammation/fibrosis on liver biopsy Cirrhosis	Cirrhosis	ALT level > 2× ULN and HBV DNA level > 20 000 IU/mL Moderate/severe inflammation/advanced fibrosis on liver biopsy Compensated cirrhosis and HBV DNA level > 2000 IU/mL Decompensated cirrhosis	Cirrhosis Age > 30 yr, persistently abnormal ALT level and HBV DNA level > 20 000 IU/mL
Treatment should be considered	ALT level > 2× ULN and HBV DNA level 2000–20 000 IU/mL ALT level 1–2× ULN and HBV DNA level > 20 000 IU/mL Age > 40 yr Evidence of moderate/severe inflammation or fibrosis	Elevated HBV DNA level and age > 30 yr Family history of hepatocellular carcinoma or cirrhosis and extrahepatic manifestations	ALT level > ULN for 3–6 mo and HBV DNA level > 2000 IU/mL Evidence of moderate/severe inflammation or fibrosis	Monitor all untreated patients every 3 mo Biopsy recommended for treatment decisions if: ⋄ Noninvasive tests suggest evidence of advanced fibrosis ⋄ ALT level is persistently elevated ⋄ Age > 35 yr ⋄ Family history of hepatocellular carcinoma or cirrhosis	Monitor all untreated patients
Monitor	ALT level < ULN	ALT level < ULN HBV DNA level < 2000 IU/mL	ALT level < ULN HBV DNA level < 2000 IU/mL		Monitor all untreated patients
Preferred first-line treatment (in alphabetical order)	Entecavir Pegylated interferon Tenofovir	Entecavir Pegylated interferon Tenofovir	Entecavir Pegylated interferon Tenofovir	Entecavir Pegylated interferon Tenofovir	Entecavir Tenofovir

Note: AASLD = American Association of the Study of Liver Diseases, ALT = alanine aminotransferase, APASL = Asian Pacific Association for the Study of the Liver, CASL = Canadian Association for the Study of the Liver, EASL = European Association for the Study of Liver, HBV = hepatitis B virus, ULN = upper limit of normal, WHO = World Health Organization.
↵* Upper limit of normal for alanine aminotransferase: men 35 U/L, women 25 U/L.
↵† Upper limit of normal for alanine aminotransferase: 40 U/L.
↵‡ Upper limit of normal for alanine aminotransferase: men 30 U/L, women 19 U/L.