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Hepatitis B virus (HBV) infection is a global epidemic with estimated mortality 0.5-1.2 million deaths a year. Long-term goal of
treatment on patients with chronic hepatitis B infection (CHB) is to reduce cirrhosis, hepatocellular carcinoma, and ultimately
improve survival.The decision on initiating viral therapy can be complex because not all the patients with CHB derive significant
clinical benefits from current medical therapies. Elevated HBV DNA level is a strong independent risk predictor of liver-related
disease outcomes. Up to date, many studies have demonstrated improved clinical outcomes with successful viral suppression in
CHB patients.Hepatic disease activity, assessed by histology and less accurately by alanine aminotransferase (ALT), is another major
decision-making factor on initiating anti-viral therapy in patients with CHB. As in immune tolerance phase of CHB, characterized
by high HBV DNA level, normal ALT, and no/minimal hepatic inflammation, disease progression is negligible.Treatment on these
patients is therefore unlikely to alter long-term clinical outcomes. However, close monitoring of ALT level is highly recommended
during immune tolerant phase astransition to immune clearance phase may occur. Anti-viral therapy is often required during immune
clearance phase due to rapid disease progression.In patients with low HBV DNA and normal ALT, as seen in inactive carrier, medical
therapy is typically not beneficial in long-term out comes due to minimal risk of developing hepatic complications.
Na Li had her PhD training at University of Louisville, USA. She then completed her Gastroenterology and Hepatology training at North Shore LIJ Medical Center. She
worked with a renowned Hepatologist David Bernstein and developed strong clinical interests on viral hepatitis and metabolic liver disease. She is currently a Clinical
Assistant Professor at Ohio State University. She looks forward to conducting more clinical studies on these hepatology fields and collaborating with field experts.
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