Should Treatment Indications for Chronic Hepatitis B Be Expanded?

Wen Juei Jeng, Anna S. Lok*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

46 Scopus citations


Background & Aim: Antiviral therapy has greatly improved the outcomes of patients with chronic hepatitis B virus (HBV) infection and active liver disease or advanced fibrosis/cirrhosis. However, current treatment does not eradicate HBV and long-term treatment is needed in most patients to maintain clinical benefit. Thus, professional society guidelines do not recommend treatment of all patients with chronic HBV infection. This review article will examine evidence for and against expansion of treatment to patients in whom treatment is not recommended based on current guidelines. Results: Available data support expanding treatment to immune tolerant patients and patients in the grey zones who have evidence of active/advanced liver disease based on liver biopsy or non-invasive tests and those who remain in the immune tolerant phase after age 40. Evidence supporting treatment expansion to confirmed inactive carriers and other immune tolerant patients is lacking. Conclusions: HBV treatment indications can be more liberal when new therapies that can achieve HBsAg loss safely in a high percentage of patients after a finite course of treatment are available.

Original languageEnglish
Pages (from-to)2006-2014
Number of pages9
JournalClinical Gastroenterology and Hepatology
Issue number10
StatePublished - 10 2021

Bibliographical note

Publisher Copyright:
© 2021 AGA Institute


  • Antiviral Therapy
  • Guidelines
  • Immune Tolerant
  • Inactive Carrier


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