Michal R. Piják, Peter Jarčuška, Marián Oltman, Veronika Csibová
One of the main goals of the first part of this review was to point out the differences between updated (2009) and original (2003) EASL (European Association for the Study of the Liver) guidelines and also most recent guidelines developed by the AASLD (American Association for the Study of Liver Diseases), the APASL (Asian Pacific Association for the Study of the Liver) and the U.S. panel of nationally recognized liver specialists). In the absence of new therapeutics, research in the last three years focused on broadening the group of patients that could be treated and novel ways to follow patients on therapy, including early predictors of response. A significant progress in this area is closely linked to the observation, that drops in quantitative surface antigen are more predictive than the decline in HBV DNA, particularly with the oral anti-viral drugs. It is also pointed out that lowered cut-off level of HBV-DNA to 104 copies/mL for all patients and the availability of five oral drugs, expanded the indications for treatment. Due to these advances, the decision to initiate treatment is now easy in patients with liver failure or cirrhosis. However, there continues to be debate regarding when treatment should be initiated in patients with precirrhotic liver disease with persistently normal ALT levels.