Transient abnormalities in ALT levels or HBV DNA levels may be observed in approximately two-thirds of patients who successfully discontinued NUC and would finally achieve the inactive carrier state. Therefore, even if the ALT level or the HBV BGB324 concentration DNA level shows mild elevations, it is possible to keep following up without retreatment. However, patients who meet the following condition are less likely to finally achieve the inactive carrier state and should be considered for NUC retreatment. Condition to consider retreatment with NUC ALT ≥80 IU/L or HBV DNA ≥5.8 log copies/mL after discontinuation The status differs in each patient. Objectives and significance also differ by patient.

Thus, doctors must determine whether NUC should be discontinued or not in consideration of those conditions. In case of considering discontinuation, it is recommended to consult with a specialist of hepatic diseases. In case of retreatment with NUC due to hepatitis

relapse after discontinuation, it is unknown whether PFT�� cell line it results in higher emergence of strains resistant to NUC or not compared with patients without discontinuation. Because HBV carriers rarely experience hepatitis relapse even in the inactive carrier state (HBV DNA <4.0 log copy/mL and ALT <30 IU/L), they must be followed up after successful discontinuation. Liver carcinogenesis also requires follow up. The followings are included in future issues;

improvement of accuracy in the criteria for discontinuation of NUC; investigation of the criteria used in these guidelines in a prospective study; and investigation of the MCE way to actively discontinue NUC using sequential treatment with interferon. “
“In clinical practice, it is important to assess the severity of liver fibrosis in patients with various liver diseases to determine the prognosis, decide treatment, and monitor disease progression and response to treatment. Liver biopsy is limited by its invasiveness and patient acceptability. The development of transient elastography provides clinicians with a non-invasive, accurate, and reproducible tool to estimate liver fibrosis. The technique has been validated among many liver diseases and requires only simple training. Due to its non-invasive nature and ease of use, transient elastography can be used repeatedly on patients, and is optimal for large-scale epidemiological studies, in which stable patients with no indication for liver biopsy can also be included. However, falsely-high liver stiffness measurements might occur during acute hepatitis, extrahepatic cholestasis, congestive heart failure, and amyloidosis. Failed acquisition is also common in obese patients. The development of S and XL probes might cater for different population groups, but calibration in patients with liver biopsy is essential.