[Optimal timing significance and clinical implications for the treatment of chronic HBV-infected patients with normal ALT].

Due to the difference in infection time and immune clearance ability, patients with chronic hepatitis B virus (HBV) infection may appear as virus carrier or chronic active hepatitis. Alanine aminotransferase (ALT) is the most sensitive biomarkers for evaluating liver inflammation. Current anti-HBV drugs, nucleoside analogues (NAs) and peginterferon α, can only achieve satisfactory results when liver inflammation is active. Therefore, international authoritative guidelines recommend HBV DNA positive and ALT > 2-fold the upper limit of normal (2×ULN) as indications for treatment. However, many studies have shown that some chronic HBV infected patients with normal ALT have insidious progression to liver cirrhosis or liver failure, because of not initiating antiviral therapy in time. Hence, the disease assessment and initiation indication for treatment have received more and more attention and become a hot topic in clinical research for chronic HBV infected patients with normal ALT.