Erratum to ‘Is liver biopsy essential to identifying the immune tolerant phase of chronic hepatitis B?’ [Clin Mol Hepatol 2023;29:367-370]

Joo Hyun Oh; Dong Hyun Sinn

doi:10.3350/cmh.2023.0054e

There seems to be an error with the upper limit of normal for alanine aminotransferase (ALT) levels. The American Association for the Study of Liver Disease now recommends an upper limit of normal to be up to 35 U/L for guiding management, rather than the normal range of 29-33 U/L in healthy males. Therefore, it would be more appropriate to use “<35 U/L” as the reference range. To correct this, it is recommended to update page 2, line 10 from “<33 U/L” to “<35 U/L”, and apply the same change to the AASLD column in Table 1.

Before correction

The American Association for the Study of Liver Disease (AASLD) guidelines define immune-tolerant phase by HBeAg positivity, high serum HBV DNA levels (>10⁶ IU/mL), and normal serum ALT level (<33 U/L for males and <25 U/L for females).⁵

After correction

Table 1.

Criteria for an immune-tolerant phase of chronic hepatitis B according to different guidelines

Features	AASLD⁵	EASL⁶	APASL⁷	KASL⁸
Terminology	IT phase	HBeAg positive chronic infection	IT phase	IT phase
HBeAg	(+)	(+)	(+)	(+)
HBV DNA	>10⁶ IU/mL	>10⁷ IU/mL	Active HBV replication	>10⁷ IU/mL
ALT	Normal ALT (<33 U/L for males, <25 U/L for females)	Persistently normal (<40 U/L)	Normal ALT	Persistently normal ALT (<34 U/L for males, <30 U/L for females)
Fibrosis/inflammation	None/minimal	None/minimal	None	None/minimal
Fibrosis assessment	Consider noninvasive methods (liver stiffness measurement, APRI, or FIB-4) or liver biopsy if persistent borderline normal or slightly elevated ALT, Age >40 years of age	A liver biopsy or a non-invasive test if elevated ALT	Consider biopsy if noninvasive tests suggest evidence of significant fibrosis, ALT persistently elevated, Age >35 years, or family history of HCC/cirrhosis	Consider biopsy if persistently elevated ALT, age >35–40 years

AASLD, American Association for the Study of Liver Diseases; EASL, European Association for the Study of the Liver; APASL, The Asian Pacific Association for the Study of the Liver; KASL, The Korean Association for the Study of the Liver; HBeAg, hepatitis B e antigen; HBV, hepatitis B virus; ALT, alanine aminotransferase; APRI, AST to Platelet Ratio Index; FIB-4, fibrosis-4; HCC, hepatocellular carcinoma; IT, immune-tolerant.

Table 1.

Criteria for an immune-tolerant phase of chronic hepatitis B according to different guidelines

Features	AASLD⁵	EASL⁶	APASL⁷	KASL⁸
Terminology	IT phase	HBeAg positive chronic infection	IT phase	IT phase
HBeAg	(+)	(+)	(+)	(+)
HBV DNA	>10⁶ IU/mL	>10⁷ IU/mL	Active HBV replication	>10⁷ IU/mL
ALT	Normal ALT (<35 U/L for males, <25 U/L for females)	Persistently normal (<40 U/L)	Normal ALT	Persistently normal ALT (<34 U/L for males, <30 U/L for females)
Fibrosis/inflammation	None/minimal	None/minimal	None	None/minimal
Fibrosis assessment	Consider noninvasive methods (liver stiffness measurement, APRI, or FIB-4) or liver biopsy if persistent borderline normal or slightly elevated ALT, Age >40 years of age	A liver biopsy or a non-invasive test if elevated ALT	Consider biopsy if noninvasive tests suggest evidence of significant fibrosis, ALT persistently elevated, Age >35 years, or family history of HCC/cirrhosis	Consider biopsy if persistently elevated ALT, age >35–40 years