Retreatment decision for hepatitis B flare.

The point of liver biopsy for significant inflammation and/or fibrosis may be important for patients with normal ALT but not for hepatitis flare (ALT elevation >5 times upper limit of normal). Since hepatitis flares has been considered as results of endogenous immune response against HBV, patients with hepatitis flare are associated with different degree of significant necroinflammatory activity. The most important step of management for patients with hepatitis flare is to ensure safety that is to prevent hepatic decompensation, especially in patients with advanced fibrosis, and to treat patients with overt hepatic decompensation immediately [2].