Clin Mol Hepatol > Volume 29(3); 2023 > Article
Oh and Sinn: Erratum to ‘Is liver biopsy essential to identifying the immune tolerant phase of chronic hepatitis B?’ [Clin Mol Hepatol 2023;29:367-370]
There seems to be an error with the upper limit of normal for alanine aminotransferase (ALT) levels. The American Association for the Study of Liver Disease now recommends an upper limit of normal to be up to 35 U/L for guiding management, rather than the normal range of 29-33 U/L in healthy males. Therefore, it would be more appropriate to use “<35 U/L” as the reference range. To correct this, it is recommended to update page 2, line 10 from “<33 U/L” to “<35 U/L”, and apply the same change to the AASLD column in Table 1.
Before correction
The American Association for the Study of Liver Disease (AASLD) guidelines define immune-tolerant phase by HBeAg positivity, high serum HBV DNA levels (>106 IU/mL), and normal serum ALT level (<33 U/L for males and <25 U/L for females).5
After correction
The American Association for the Study of Liver Disease (AASLD) guidelines define immune-tolerant phase by HBeAg positivity, high serum HBV DNA levels (>106 IU/mL), and normal serum ALT level (<35 U/L for males and <25 U/L for females).5
Table 1.
Criteria for an immune-tolerant phase of chronic hepatitis B according to different guidelines
Features AASLD5 EASL6 APASL7 KASL8
Terminology IT phase HBeAg positive chronic infection IT phase IT phase
HBeAg (+) (+) (+) (+)
HBV DNA >106 IU/mL >107 IU/mL Active HBV replication >107 IU/mL
ALT Normal ALT (<33 U/L for males, <25 U/L for females) Persistently normal (<40 U/L) Normal ALT Persistently normal ALT (<34 U/L for males, <30 U/L for females)
Fibrosis/inflammation None/minimal None/minimal None None/minimal
Fibrosis assessment Consider noninvasive methods (liver stiffness measurement, APRI, or FIB-4) or liver biopsy if persistent borderline normal or slightly elevated ALT, Age >40 years of age A liver biopsy or a non-invasive test if elevated ALT Consider biopsy if noninvasive tests suggest evidence of significant fibrosis, ALT persistently elevated, Age >35 years, or family history of HCC/cirrhosis Consider biopsy if persistently elevated ALT, age >35–40 years

AASLD, American Association for the Study of Liver Diseases; EASL, European Association for the Study of the Liver; APASL, The Asian Pacific Association for the Study of the Liver; KASL, The Korean Association for the Study of the Liver; HBeAg, hepatitis B e antigen; HBV, hepatitis B virus; ALT, alanine aminotransferase; APRI, AST to Platelet Ratio Index; FIB-4, fibrosis-4; HCC, hepatocellular carcinoma; IT, immune-tolerant.

Table 1.
Criteria for an immune-tolerant phase of chronic hepatitis B according to different guidelines
Features AASLD5 EASL6 APASL7 KASL8
Terminology IT phase HBeAg positive chronic infection IT phase IT phase
HBeAg (+) (+) (+) (+)
HBV DNA >106 IU/mL >107 IU/mL Active HBV replication >107 IU/mL
ALT Normal ALT (<35 U/L for males, <25 U/L for females) Persistently normal (<40 U/L) Normal ALT Persistently normal ALT (<34 U/L for males, <30 U/L for females)
Fibrosis/inflammation None/minimal None/minimal None None/minimal
Fibrosis assessment Consider noninvasive methods (liver stiffness measurement, APRI, or FIB-4) or liver biopsy if persistent borderline normal or slightly elevated ALT, Age >40 years of age A liver biopsy or a non-invasive test if elevated ALT Consider biopsy if noninvasive tests suggest evidence of significant fibrosis, ALT persistently elevated, Age >35 years, or family history of HCC/cirrhosis Consider biopsy if persistently elevated ALT, age >35–40 years

AASLD, American Association for the Study of Liver Diseases; EASL, European Association for the Study of the Liver; APASL, The Asian Pacific Association for the Study of the Liver; KASL, The Korean Association for the Study of the Liver; HBeAg, hepatitis B e antigen; HBV, hepatitis B virus; ALT, alanine aminotransferase; APRI, AST to Platelet Ratio Index; FIB-4, fibrosis-4; HCC, hepatocellular carcinoma; IT, immune-tolerant.


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