BACKGROUND KNOWLEDGE: Since the publication of the fourth edition of the Asia-Pacific CHB Therapeutic Consensus in September 2008, a wealth of recent data on the natural history and treatment of chronic HBV infection has been reported. These include asymptomatic infected patients with chronic HBV infection, community-based cohort studies, non-invasive methods of liver fibrosis assessment, the use of HBsAg quantification, more effective new therapeutic agents (tenofovir) and new treatment strategies all feature prominently in the new guidelines. The evidence relied on for each recommendation of the new APASL guidelines is divided into four levels: I (at least one well-designed randomized controlled trial), II (well-designed cohort or case-control study), III (series of cases, case reports or flawed clinical trials), and IV (views of relevant authoritative experts based on clinical experience, descriptive studies or expert meeting reports). These recommendations are divided into two types: A, highly recommended; B, generally recommended. Recommendations: Recommendation 1: Mandatory thorough evaluation and counseling guidance must be given to patients before antiviral therapy is administered. Indications for treatment (IIA). Recommended recommendation 2: Antiviral therapy should not be administered to patients with viral replication but persistently normal or slightly elevated serum ALT levels unless the patient has severe liver fibrosis or cirrhosis. These patients need to be followed closely and monitored for HCC every 3 to 6 months (ⅠA). Recommendation 3: Evaluation for liver fibrosis is recommended for patients with viremia who also have ALT at high normal levels or slightly elevated and are older than 40 years of age, except in patients who already have evidence of clinically diagnosed cirrhosis. Recommendation 4: Antiviral therapy should be considered for chronic HBV infection with ALT > 2ULN and HBVDNA > 20,000 IU/ml (105 copies/ml) in HBeAg-positive patients and HBVDNA > 2,000 IU/ml (104 copies/ml) in HBeAg-negative patients. The presence of severe liver fibrosis or cirrhosis, no matter how high the ALT level is, should be considered for antiviral therapy (ⅠA). If significant liver failure is imminent or has occurred, antiviral therapy should be started as early as possible. In addition to the above, observation for 3 to 6 months is recommended to ensure the necessity of treatment (IIA). Indications for re-treatment are the same as above. Recommended recommendation 5: Patients with primary treatment may be treated with conventional interferon 5-10 MU 3 times a week [IB], or PegIFNα-2a 180 μg or 1-1.5 μg/Kg once a week (IA); or entecavir 0.5 mg once a day (IA); or tenofovir 300 mg once a day (IA); or adefovir 10 mg once a day (IB); or telbivudine 600mg once daily (ⅠB); or lamivudine 100mg once daily (ⅠB). Thymosin α 1.6mg twice a week is also available (IB). Entecavir and tenofovir are also the preferred recommended options in this setting. Recommended recommendation 6: ALT, HBeAg or HBVDNA (ⅠA) should be monitored at least once every 3 months during antiviral therapy. If tenofovir or adefovir is used, renal function should also be monitored (ⅠA). Muscle strength should be monitored for diminished muscle strength when treated with tenifovir (IIIA). During the application of interferon therapy, monitoring of complete blood count and other adverse drug reactions must be mandatory (IA). Recommendation 7: After completion of antiviral therapy, ALT and HBVDNA should be monitored monthly for the first 3 months to detect early relapse, and every 3 months thereafter. If asymptomatic, monitor every 3 months (for patients with cirrhosis) to 6 months (for patients who have developed a response) thereafter (IIA). In non-responders, HBV markers should be further monitored to identify delayed response and re-treatment when indicated (IIA). Recommendation 8: For conventional interferon, the current recommended regimen is 4 to 6 months for HBeAg-positive patients (IA) and at least 1 year for HBeAg-negative patients (IA). For PegIFN, the recommended duration of therapy is 12 months (IA). For Thymosin α1, the recommended course is 6 months for both HBeAg-positive patients (IA) and HBeAg-negative patients (IIB). Recommendation 9: For oral antivirals, discontinuation may be considered in HBeAg-positive patients when HBeAg serologic conversion with undetectable HBVDNA is confirmed for at least 12 months (IIA). In HBeAg-negative patients, if HBsAg remains positive it is unclear how long treatment needs to be continued, but undetectable HBVDNA (IIA) at 3 different time points at least 2 years of treatment and at least 6 months apart may be considered for discontinuation of treatment. For well adherent primary treatment patients with primary treatment failure at 3 months of initiation or suboptimal viral control at month 6, if already treated with lamivudine, telbivudine or adefovir, treatment may be switched to a more potent or additional drug without cross-resistance (IIIA). Recommendation 10-1: For women of childbearing age who are not yet pregnant, interferon-based therapy (IA) is preferred and pregnancy should not occur during interferon therapy. Those who are pregnant and need treatment can be treated with pregnancy grade B oral medication (IIA). Recommendation 10-2: To prevent mother-to-child transmission, pregnant women with HBVDNA >2×106IU/mL can be treated with tenofovir (IIA) in late pregnancy, and tenofovir can also be one of the options (IIIA). Recommendation 11: Antiretrovirals, including those with tenofovir and emtricitabine/lamivudine, are the primary treatment modality for most patients with HIV co-infection with HBV. If CD4 > 500cells/mm3 and antiretroviral therapy is not currently required, adefovir or PegIFNα therapy (IIA) may be an option. Recommendation 12: In patients with coexisting HCV or HDV infection, care should be taken to identify which virus is causing the predominant liver damage and to develop a treatment plan to give treatment accordingly (III). Recommendation 13: For patients with significant or imminent hepatic decompensation and initial treatment, use entecavir or tenofovir (IA). However, for patients on initial oral antivirals, treatment with telbivudine, lamivudine, or adefovir (IB) may also be used. Renal function and lactate must be monitored in this population, especially in patients with MELD parity scores above 20 (IIIA). Recommendation 14: For patients who develop resistance during lamivudine treatment, adefovir (IA) may be added to continued lamivudine; a switch to tenofovir (IIA) is also an option. Switching to entecavir 1 mg/d (IB) is not recommended. For patients who develop resistance during adefovir therapy, add lamivudine, telbivudine, or entecavir or switch to tenofovir (IIIA). For patients who develop resistance during entecavir therapy, add tenofovir or adefovir (IIIA). For patients who have failed or developed resistance during lamivudine or telbivudine in combination with adefovir, a switch to entecavir plus tenofovir (IIA) is recommended. Treatment with interferon or other nucleoside analogues may also be switched to interferon or other nucleoside analogues (IIIA) for those who develop resistance (IA) during lamivudine treatment. Recommendation 15-1: Patients should be screened for HBsAg (IVA) prior to receiving immunosuppressive therapy or chemotherapy. If the patient is HBsAg positive, oral nucleoside analog therapy may be initiated if clinically indicated (IA). Alternatively, prophylactic treatment with lamivudine may be initiated before the start of immunosuppressive therapy or chemotherapy and continued until at least 6 months after the end of immunosuppressive therapy or chemotherapy (IA). Entecavir and tenofovir may also be used for prophylaxis (IIIA). Recommendation 15-2: Patients who are ready to receive anti-CD20 drugs need to be screened for anti-HBc and if positive need to be closely monitored for HBVDNA levels (IVA). Recommendation 16-1: Nucleoside (acid) analog therapy (IVA) should be given to all patients with detectable HBVDNA in liver failure associated with HBV infection. Lamivudine combined with low-dose HBIG (week 1, 400-800 U, intramuscularly, once daily; given long-term thereafter, 400-800 U, once monthly) is safe and effective in preventing HBV reinfection in allografts (IIA). Lamivudine combined with adefovir or entecavir may be considered for prophylaxis (IIA). Recommendation 16-2: Prophylaxis with adefovir instead of HBIG at least 1 year after liver transplantation provides safe and cost-effective prophylaxis (IIA). For patients considered “low risk”, lamivudine alone may also be considered in the later post-transplant period (IA). Recommendation 16-3: Long-term prophylaxis with lamivudine or HBIG is indicated in patients without previous HBV infection who receive a liver from an anti-HBc-positive donor (IIIA). Recommendation 17: Patients with hepatocellular carcinoma with HBVDNA higher than 2000 IU/ml should be treated with antiviral therapy with nucleoside analogues before and after hepatocellular carcinoma treatment, as in patients with chronic hepatitis B who have not developed hepatocellular carcinoma (IIIB). Patients with hepatocellular carcinoma should start antiviral therapy with nucleoside analogues before receiving arterial chemoembolization therapy (IIA).