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Erratum to ‘Is liver biopsy essential to identifying the immune tolerant phase of chronic hepatitis B?’ [Clin Mol Hepatol 2023;29:367-370]

Article information

Clin Mol Hepatol. 2023;29(3):828-829
Publication date (electronic) : 2023 April 13
doi : https://doi.org/10.3350/cmh.2023.0054e
Joo Hyun Oh1, Dong Hyun Sinn,2orcid_icon
1Department of Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
2Department of Medicine,Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Corresponding author : Dong Hyun Sinn Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3409, Fax: +82-2-3410-6983; E-mail: dh.sinn@samsung.com

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

Criteria for an immune-tolerant phase of chronic hepatitis B according to different guidelines

Criteria for an immune-tolerant phase of chronic hepatitis B according to different guidelines

Article information Continued

Copyright © 2023 by The Korean Association for the Study of the Liver

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.