Selection of optimal treatment timing for interferon therapy for chronic hepatitis B Patients with chronic hepatitis B in the immune clearance phase are suitable for antiviral therapy. Patients in this period have elevated ALT levels accompanied by necrosis of hepatocytes in response to inflammation and lower serum HBV DNA levels than immune tolerant patients. The timing of interferon therapy is based on the patient’s ALT level, which is a more visual indicator of the immune response in patients with chronic hepatitis B. ALT levels in patients with immune clearance show a dynamic change of “rise, fall and normalization” depending on the state of immune response, while patients with higher ALT levels have a stronger immune response, those with lower ALT have a weaker immune response, and those with normal ALT have a weaker immune response. above), lower levels of serum HBV DNA (e.g., 1×106 copies/mL or less), and more pronounced hepatocyte inflammatory response necrosis (e.g., G2 or above) have a higher rate of sustained response after antiviral therapy. However, the immune response of patients is too strong, and the immune response may be further enhanced during interferon therapy, with the risk of liver failure. Therefore, the guidelines of the relevant professional societies in China and internationally agree that an elevated ALT level (2-10)×ULN is an appropriate time for interferon therapy, which is effective and safe. patients with normal or mildly elevated ALT levels (<2×ULN) have a lower response rate with interferon therapy; patients with significantly elevated ALT (>10×ULN) have a stronger immune response and may be at risk of failure to compensate after treatment. Experts recommend that: when considering interferon therapy in patients with ALT of (1 to 2) × ULN or ALT > 10 × ULN. ① For patients with recurrent mildly elevated ALT levels [(1 to 2) × ULN] or normal ALT, liver tissue biopsy is recommended if the patient is older (40 years or older), has a family history of chronic hepatitis B or hepatocellular carcinoma, is HBeAg negative, and has chronic liver lesions suggested by B-mode ultrasound or CT examination. Antiviral therapy (including interferon) is recommended for patients with G2 or above. ② Antiviral therapy should be administered for significantly elevated ALT levels (>10×ULN). If interferon is considered, close observation of changes in the disease should be carried out, while symptomatic and supportive treatment such as liver protection should be given as appropriate. Once the ALT level starts to decrease. or has decreased to <10×ULN without significant bilirubin elevation, interferon therapy may be used. The patient can be treated at regular doses or start with small doses according to the patient's specific situation; ③ When considering interferon therapy for patients with significantly elevated ALT levels (>10×ULN), it should be implemented or directed by experts with extensive experience in the clinical application of interferon. Changes in the condition should be closely observed during treatment, and adjustments to the treatment plan can be considered when necessary.