8月份刚刚出版的《临床胃肠病学》（Clinical Gastroenterology and Hepatology）杂志上刊登了Keeffe等8位教授署名撰写的《美国慢性乙型肝炎病毒感染治疗规范》最新版，其中的治疗标准和治疗终点有所变化。
更新后的首要治疗目标是，将HBV-DNA降至并维持在尽可能低的水平，在此前提下，才可能达到其他目标，包括组织学改善、ALT复常等。
治疗标准如下：
对于HBeAg阳性患者，①当HBV-DNA<10E5cp/ml、ALT正常时，只要患者有明显的组织学改变，即使HBV-DNA水平低，也考虑治疗。②当HBV-DNA>10E5cp/ml、ALT正常时，考虑肝活检，特别是年龄>35岁人群，如有明显病变需要治疗，首选恩替卡韦、阿德福韦或聚乙二醇干扰素α-2a。③当HBV-DNA>10E5cp/ml、ALT升高时，进行治疗，首选恩替卡韦、阿德福韦或聚乙二醇干扰素α-2a，当HBV-DNA水平较高时，优先选择恩替卡韦或阿德福韦。
对于HBeAg阴性患者，①当HBV-DNA<10E4cp/ml、ALT正常时，如有明显组织学改变，即使HBV-DNA水平低，也考虑治疗。②当HBV-DNA≥10E4cp/ml、ALT正常时，考虑肝活检，如有明显病变需要治疗。③当HBV-DNA≥10E4cp/ml、ALT升高时需治疗，首选恩替卡韦、阿德福韦或聚乙二醇干扰素α-2a，而且长期治疗需用口服抗病毒药物。
需要注意的是，以上治疗标准中规定，只要ALT升高，就需要治疗，而不一定要>2×ULN。尤其需要注意的是，男性ALT正常上限为30U/L，女性为19U/L。
同2004年AASLD乙肝指南相比，此次更新的乙肝治疗规范向前迈出了一大步，但还没有达到最佳，理想的治疗终点是，HBV-DNA永久处于低水平（<10E4cp/ml，PCR阴性尤佳），ALT<0.5×ULN，cccDNA从肝内清除，目前看来，这一目标并非遥不可及。
Clin Gastroenterol Hepatol. 2006 Aug;4(8):936-62.
A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: an update.
Keeffe EB, Dieterich DT, Han SH, Jacobson IM, Martin P, Schiff ER, Tobias H, Wright TL.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, CA 94304, USA.
Chronic hepatitis B (CHB) is an important public health problem worldwide and in the United States, with approximately 25% of patients infected as neonates dying prematurely from cirrhosis or liver cancer. A treatment algorithm for CHB previously developed and published by a panel of United States hepatologists was revised based on new developments in the understanding of CHB, the availability of more sensitive molecular diagnostic testing, the addition of new treatments, and better understanding of the advantages and disadvantages of approved therapies. This updated algorithm is based on available evidence using a systematic review of the scientific literature. Where data are lacking, the panel relied on clinical experience and consensus expert opinion. Serum HBV DNA can be detected at levels as low as 10 IU/mL using molecular assays and should be determined to establish a baseline level before treatment, monitor response to antiviral therapy, and survey for the development of drug resistance. The primary aim of antiviral therapy is durable suppression of serum HBV DNA to the lowest levels possible. The threshold level of HBV DNA for determination of candidacy for therapy is 20,000 IU/mL or more for patients with hepatitis B e antigen-positive CHB. A lower serum HBV DNA threshold of 2000 IU/mL or more is recommended for patients with hepatitis B e antigen-negative CHB, and 200 IU/mL or more for those with decompensated cirrhosis. Interferon alfa-2b, lamivudine, adefovir, entecavir, and peginterferon alfa-2a all are approved as initial therapy for CHB and have certain advantages and disadvantages. Issues for consideration include efficacy, safety, incidence of resistance, method of administration, and cost.