Should chronic HBV infected patients with normal ALT treated: debate

Alanine aminotransferase (ALT) levels have traditionally been used for treatment decisions in chronic hepatitis B virus (CHBV) infected patients. But recent data have raised doubts on this wisdom, as a significant proportion of CHBV infected patients with normal ALT have high HBVDNA levels and significant liver injury at presentation especially in areas of intermediate to high endemicity. A normal ALT value only identifies patients less likely to respond to current treatments, rather than patients who are not in need of the treatment. Patients with CHBV infection with normal ALT should be considered for treatment based on the HBV DNA levels and histological injury.