Sanai FM, et al. – The diagnostic accuracy of aspartate aminotransferase (AST)–to–platelet ratio index (APRI), fibrosis–4 index (FIB–4), AST/alanine aminotransferase (ALT) ratio (AAR), and age–platelet index (API) for significant fibrosis (Metavir F2–4) were assessed in low–replicative (HBV DNA <20,000 IU/mL) chronic hepatitis B virus (HBV) patients. For fibrosis diagnosis at conventional cut–offs, all 4 biomarkers in both, low and high–replicative HBV showed modest accuracy. Lowering the cut–offs could increase the diagnostic relevance of these biomarkers, especially for APRI and FIB–4 in low–replicative disease.