What are the standards for antiviral treatment of hepatitis B?

Generally, the decision to initiate antiviral therapy for hepatitis B should be based on a comprehensive assessment of viral replication status, liver function, and severity of liver damage. Key criteria include HBV DNA levels, persistently elevated serum ALT, liver histological abnormalities, treatment indications for special populations, and treatment standards for patients with cirrhosis. A detailed analysis is as follows:

1. **HBV DNA level meets treatment threshold**: Quantitative HBV DNA testing is one of the key indicators. In chronic hepatitis B patients, whether HBeAg-positive or HBeAg-negative, detectable HBV DNA indicates active viral replication and justifies initiation of antiviral therapy.

2. **Persistently elevated serum ALT**: When serum alanine aminotransferase (ALT) levels remain elevated or repeatedly exceed twice the upper limit of normal—and other causes of liver injury such as fatty liver or drug-induced damage have been ruled out—it suggests liver inflammation caused by hepatitis B virus, warranting timely initiation of antiviral therapy.

3. **Liver histological abnormalities**: Liver biopsy showing inflammation and necrosis grade ≥G2 or fibrosis stage ≥S2 warrants antiviral treatment even if ALT levels are not significantly elevated, in order to prevent further progression of liver disease.

4. **Treatment indications for special populations**: Patients with cirrhosis who are hepatitis B surface antigen (HBsAg)-positive require long-term antiviral therapy regardless of HBV DNA levels or ALT values. Additionally, patients with hepatitis B-related liver failure or hepatocellular carcinoma, as well as hepatitis B virus carriers undergoing chemotherapy or immunosuppressive therapy, should also start antiviral treatment early.

5. **Treatment criteria for cirrhotic patients**: For patients with compensated cirrhosis, antiviral therapy is indicated if HBV DNA is detectable, or if HBV DNA is negative but HBeAg-positive. For those with decompensated cirrhosis, treatment should be initiated immediately upon detection of HBsAg positivity, irrespective of HBV DNA levels or ALT values.

Antiviral treatment for hepatitis B must be evaluated and individualized by a qualified physician. Regular monitoring of HBV DNA, liver function, and other relevant markers is required during treatment. Patients must strictly adhere to medical instructions regarding medication, avoid stopping treatment or adjusting doses without guidance, maintain regular daily routines, and refrain from alcohol consumption to reduce additional liver burden.