As opposed to European (EASL) 2012, Asian-Pacific (APASL) 2012, American (AASLD) 2009, and World Health Organisation (WHO) 2015 major guidelines for the treatment of chronic Hepatitis B, the following 3 guidelines are more strict on the conditions leading to necessity of treatment for Hepatitis B, HBeAg negative carriers:
Canadian 2009, Japanese (JSH) 2013, and UK/British (NICE) 2013 guidelines are more "strict" when it comes to treatment of negative HBsAg patients, especially in the way they consider the ALT value. The treatment necessity criteria of these 3 guidelines can roughly be summarised in the words of NICE 2013 guidelines:
"Offer antiviral treatment to adults aged 30 years and older who have HBV DNA greater than 2000 IU/ml and abnormal ALT (greater than or equal to 30 IU/L in males and greater than or equal to 19 IU/L in females) on 2 consecutive tests conducted 3 months apart."
So there is a very significant difference between the upper 2 groups of the guidelines, as ALT of most of negative HBeAg carriers often varies and is for many often between 30 and 40. The very important question arrises here, and that is for those who have HBV DNA > 2000 and whose ALT usually is between 30 and 40, should they follow the first group of guidelines which recommend no treatment for those HepB carriers, or the second group of guidelines that do recommend such patients to be treated!!!
What are your perspectives on this crucial issue on treatment (necessity of medications)???