Recently I have often received letters from patients who have just started antiviral therapy saying that their ALT is elevated after antiviral therapy and that they are very frightened and worried that their liver disease will worsen. I invite you to take a look at the following chart: In fact, at the beginning of antiviral therapy, many patients will experience a transient mild increase in ALT as HBV DNA decreases. This is because the drugs, while suppressing and clearing the virus, can stimulate the body’s immune response, causing some liver cells with the virus to be destroyed, resulting in an increase in ALT. This is often the initial manifestation of drug efficacy and is a normal phenomenon. Moreover, the more obvious the decrease in HBV DNA, the more likely the ALT will be elevated, with 3% to 10% of patients having significantly elevated ALT. Therefore, at the beginning of antiviral treatment, patients should pay attention to rest and not overexert themselves, and patients with high ALT can take some liver-protective and enzyme-lowering drugs together. During the first 3 months of treatment, liver function and HBV DNA should be checked once every 4-6 weeks, and if the ALT is significantly elevated, 5 times higher than the upper limit of the normal value, or if the patient has obvious symptoms, he can take some liver-protective and enzyme-lowering drugs; if the elevation is not much, or if there are no obvious symptoms, there is no need to add new drugs and continue antiviral treatment. Generally, as HBV DNA continues to decline, ALT will return to normal automatically at about 3 months of treatment. In a very small number of patients, the ALT may rise to more than 10 times the upper limit of the normal value, requiring hospitalization.