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Generally, the decision on how to manage a patient with CHB relies on a careful balance of patient age, severity of liver disease, likelihood of response, and potential adverse events and complications.
Current guidelines lay down a series of criteria to help establish whether a patient is at risk of progressive disease and in need of treatment. The decision to treat is based on the presence and levels of certain serum markers, namely HBV DNA and ALT. Liver biopsy, although not considered essential, may help to establish underlying liver damage and aid the decision on whether or not to treat.
Reference:
1. Lok, McMahon. Chronic Hepatitis B. AASLD Guideline update 2007. Available from: www.aasld.org/practiceguidelines (Accessed August 2008)