update context : latest

core/hbv_assessment.py

@@ -123,7 +123,9 @@ SASLT_GUIDELINES = """
 • Patients with HBV DNA > 20,000 IU/mL and ALT > 2xULN, regardless of the degree of fibrosis (Grade B) [SASLT 2021, p. 6]
 • Patients with HBeAg-positive chronic HBV infection (persistently normal ALT and high HBV DNA levels) may be treated if they are > 30 years, regardless of the severity of liver histological lesions (Grade D) [SASLT 2021, p. 6]
 • Patients with chronic HBV infection (HBV DNA > 2,000 IU/mL, ALT > ULN), regardless of HBeAg status, and a family history of HCC or cirrhosis and extrahepatic manifestations (Grade D) [SASLT 2021, p. 6]
-
+• Non‑cirrhotic patients should be considered for treatment if they have HBV DNA levels >2,000 IU/mL, serum ALT >~40 IU/L and severity of liver disease assessed by liver biopsy showing at least moderate necroinflammation and/or at least moderate fibrosis. 
+Patients with HBV DNA greater than 20,000 IU/mL and ALT greater than 2x ULN can begin treatment without a liver biopsy. 
+Patients with HBV DNA >2,000 IU/mL and at least moderate fibrosis may initiate treatment even if ALT levels are normal.
 
 ### 2. MANAGEMENT ALGORITHM [SASLT 2021, p. 6]
 
@@ -196,6 +198,9 @@ SASLT_GUIDELINES = """
 
 * **ALT (Alanine Aminotransferase):** Normal range in Adults falls between 4-42 units/L (U/L).
 * **ULN (Upper Limit of Normal):** ULN means Upper Limit of Normal for ALT which is set at 40 units/L for the purpose of these guidelines.
+* ** Necroinflammatory activity scale; A1 = mild, A2 = moderate, A3 = severe
+Liver fibrosis is usually classified into five stages: 
+F0—no fibrosis; F1—mild fibrosis, pericellular collagen deposits; F2—moderate fibrosis, beginning bridging fibrosis; F3—severe fibrosis, defined as presence of numerous bridges and septa; F4—cirrhosis
 """