Update assess and assess/text endpoints to simplify context handling

- Removed RAG pipeline step: "Retrieve relevant guidelines from vector store using hybrid_search"
- Included page contents with page numbers directly as prompt context
- Ensured outputs cite corresponding page numbers as usual
- Context now explicitly includes SASLT guideline pages 3–10 for HBV phases, risk factors, treatment indications, monitoring, and therapy recommendations

api/routers/hbv_assessment.py

@@ -23,10 +23,9 @@ async def assess_patient(patient: HBVPatientInput) -> HBVAssessmentResponse:
     
     This endpoint:
     1. Validates patient data
-    2. Creates intelligent search query based on patient parameters
-    3. Retrieves relevant SASLT 2021 guidelines from vector store
-    4. Uses LLM to analyze patient against retrieved guidelines
-    5. Returns structured assessment with eligibility and comprehensive recommendations
+    2. Provides SASLT 2021 guideline pages (3, 4, 6, 7, 8, 9, 10) directly as context
+    3. Uses LLM to analyze patient against the guidelines
+    4. Returns structured assessment with eligibility and comprehensive recommendations
     
     Returns:
         HBVAssessmentResponse containing:
@@ -63,8 +62,9 @@ async def assess_patient_from_text(text_input: TextAssessmentInput) -> HBVAssess
     This endpoint:
     1. Parses free-form text to extract structured patient data using LLM
     2. Validates the extracted data
-    3. Performs the same assessment as /assess endpoint
-    4. Returns structured assessment with eligibility and recommendations
+    3. Provides SASLT 2021 guideline pages directly as context
+    4. Uses LLM to analyze patient against the guidelines
+    5. Returns structured assessment with eligibility and recommendations
     
     Example text input:
     "45-year-old male patient

core/hbv_assessment.py

@@ -6,7 +6,6 @@ import logging
 import json
 import re
 from typing import Dict, Any
-from .retrievers import hybrid_search
 from .config import get_llm
 
 logger = logging.getLogger(__name__)
@@ -72,74 +71,319 @@ def clean_json_string(json_str: str) -> str:
     return ''.join(result)
 
 
-def create_patient_query(patient_data: Dict[str, Any]) -> str:
-    """
-    Create a comprehensive search query based on patient parameters
-    
-    Args:
-        patient_data: Dictionary containing patient clinical parameters
-        
-    Returns:
-        Optimized search query string for guideline retrieval
-    """
-    query_parts = []
-    
-    # Add HBeAg status to query
-    if patient_data.get("hbeag_status") == "Positive":
-        query_parts.append("HBeAg-positive chronic hepatitis B treatment eligibility")
-    else:
-        query_parts.append("HBeAg-negative chronic hepatitis B treatment eligibility")
-    
-    # Add viral load context
-    hbv_dna = patient_data.get("hbv_dna_level", 0)
-    if hbv_dna > 20000:
-        query_parts.append("high HBV DNA level")
-    elif hbv_dna > 2000:
-        query_parts.append("moderate HBV DNA level")
-    
-    # Add ALT context
-    sex = patient_data.get("sex", "Male")
-    alt_level = patient_data.get("alt_level", 0)
-    alt_uln = 35 if sex == "Male" else 25
-    if alt_level > 2 * alt_uln:
-        query_parts.append("significantly elevated ALT")
-    elif alt_level > alt_uln:
-        query_parts.append("elevated ALT")
-    
-    # Add fibrosis context
-    fibrosis_stage = patient_data.get("fibrosis_stage", "")
-    if fibrosis_stage == "F4":
-        query_parts.append("cirrhosis treatment criteria")
-    elif fibrosis_stage == "F2-F3":
-        query_parts.append("significant fibrosis")
-    
-    # Add special populations
-    if patient_data.get("pregnancy_status") == "Pregnant":
-        query_parts.append("pregnancy antiviral prophylaxis")
-    
-    immunosuppression = patient_data.get("immunosuppression_status")
-    if immunosuppression and immunosuppression != "None":
-        query_parts.append("immunosuppression prophylactic therapy")
-    
-    coinfections = patient_data.get("coinfections", [])
-    if coinfections:
-        query_parts.append("coinfection management")
-    
-    if patient_data.get("extrahepatic_manifestations"):
-        query_parts.append("extrahepatic manifestations")
-    
-    if patient_data.get("family_history_cirrhosis_hcc"):
-        query_parts.append("family history HCC cirrhosis")
-    
-    # Combine into search query
-    base_query = " ".join(query_parts[:3])  # Use top 3 most relevant parts
-    return f"{base_query} treatment indications criteria SASLT 2021"
+# SASLT 2021 Guidelines - Hardcoded Page Contents
+SASLT_GUIDELINES = """
+----
+Page 3:
+## TABLE 2: Natural history and assessment of patients with chronic HBV infection based upon HBV and liver disease markers[1,3]
+| Phases | HBsAg/HBeAg | HBV DNA | ALT | Liver inflammation | Old terminology and Observations |
+|--------|-------------|---------|-----|-------------------|----------------------------------|
+| **PHASE 1**<br>Chronic HBV infection | High/Positive | High (>10⁷ IU/mL) | Normal | None/minimal | **"Immune tolerant"**<br>This phase is more frequent and more prolonged in subjects infected prenatally or in the first years of life. Patients are highly contagious. |
+| **PHASE 2**<br>Chronic hepatitis B | High-Intermediate/Positive | Lower (10⁴-10⁷ IU/mL) | Increased | Moderate/severe | **"Immune reactive HBeAg positive"**<br>This phase may last for several weeks to years. It may occur after several years of immune tolerance and is more frequently in subjects infected during adulthood. |
+| **PHASE 3**<br>Chronic HBV infection | Low/Negative | Low or undetectable (<2,000 IU/mL)ᵃ | Normal | None | **"Inactive carrier"**<br>This state confers a favorable long-term outcome with low risk of cirrhosis or HCC. |
+| **PHASE 4**<br>Chronic hepatitis B | Intermediate/Negative | Fluctuating levels (>2,000 IU/mL) | Fluctuating levels/Elevated* | Moderate/severe | **"HBeAg negative chronic hepatitis"**<br>Characterized by periodic reactivations. It is sometimes difficult to distinguish true inactive HBV carriers (good prognosis) from patients with active HBeAg-negative CHB (have active liver disease with a high risk of progression to advanced hepatic fibrosis, cirrhosis, and HCC) |
+| **PHASE 5**<br>Resolved HBV infection | Negative/Negative | Undetectable (<10 IU/mL) | Normal | None (HCC risk if cirrhosis has developed before HBsAg loss) | **"HBsAg negative/anti-HBc positive"**<br>Reduced risk of cirrhosis, decompensation, and HCC. Immunosuppression may reactivate HBV in these patients. |
+**Footnotes:**
+- ᵃHBV DNA levels can be between 2,000 and 20,000 IU/ml in some patients without signs of chronic hepatitis.
+- *Persistently or intermittently
+----
+
+Page 4
+## FIGURE 1: Risk Factors for HCC Development
+### Factors that affect the risk of developing HCC in diagnosed CHB patients
+#### FACTORS RELATED WITH THE HOST
+- Cirrhosis
+- Chronic hepatic necroinflammation
+- Older age
+- Male sex
+- African origin
+- Alcohol abuse
+- Chronic co-infections with other viral hepatitis or HIV
+- Diabetes or metabolic syndrome
+- Active smoking
+- Positive family history
+#### FACTORS RELATED WITH HBV PROPERTIES
+- High HBV DNA
+- High HBsAg levels
+- HBV genotypes C > B
+- Specific mutations
+----
+Page 6:
+Goal and endpoint of therapy
+The main goal of treatment for chronic HBV infection is
+to improve survival and quality of life by preventing disease
+progression to cirrhosis‑ and liver‑related complications,
+namely HCC development.[1,36] Additional goals are to
+prevent mother‑to‑child transmission, hepatitis B reactivation
+and prevention/treatment of associated extrahepatic
+manifestations. The likelihood of achieving these goals
+depends upon the timing of therapy and on the stage of
+disease and patient's age when the treatment is started.
+A further goal of treatment can be regression of fibrosis
+or cirrhosis in patients with advanced fibrosis or cirrhosis.
+In patients with HBV‑induced HCC the use of nucleos (t)
+ide analogue (NA) therapy is done mainly to suppress
+HBV replication, and to prevent recurrence of HCC after
+curative therapies. Stabilization of the HBV‑induced liver
+disease can be considered a prerequisite for the safe and
+effective application of HCC treatment.[1]
+For patients with acute hepatitis B the main goal of therapy
+is to prevent the risk of acute or subacute liver failure.
+Additional goals may consider improving the quality of
+life by reducing disease‑associated symptoms and lowering
+the risk of chronicity.[1]
+The recommendations for endpoints of chronic HBV
+therapy are shown in Table 5.
+Treatment indications
+Indications for treatment are in general the same for
+HBeAg‑positive and HBeAg‑negative patients, and
+this is based mainly upon the combination of serum
+HBV DNA levels, serum ALT levels and severity of
+disease[1] [Figure 2].
+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.
+In patients unwilling or unable to undergo liver biopsy,
+non‑invasive markers of fibrosis may instead be used to
+decide on treatment indications. Treatment indications
+should also take into account patient's age, health status, risk
+of HBV transmission, family history of HCC or cirrhosis
+and extrahepatic manifestations [Figure 2].[1]
+Recommendations for initiation of treatment
+• All patients with chronic hepatitis B (HBV DNA > 2,000 IU/mL, ALT >
+ULN), regardless of HBeAg status, and/or at least moderate liver
+necroinflammation or fibrosis (Grade A)
+• Patients with cirrhosis (compensated or decompensated), with any
+detectable HBV DNA level and regardless of ALT levels (Grade A)
+• Patients with HBV DNA > 20,000 IU/mL and ALT > 2xULN, regardless
+of the degree of fibrosis (Grade B)
+• 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)
+• 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)
+Monitoring of therapy of patients currently not treated
+Patients not candidate for antiviral therapy should be
+periodically assessed to determine whether an indication
+for treatment has developed. Serum ALT and HBV
+DNA levels as well as fibrosis severity by non‑invasive
+markers should be regularly evaluated. HBeAg‑positive
+untreated patients should be tested for ALT every 3 months,
+Figure 2: Algorithm for the management of HBV infection:
+• HBsAg positive with chronic HBV infection and no signs of chronic hepatitis → Monitor (HBsAg, HBeAg, HBV DNA, ALT, fibrosis assessment). Consider: risk of HCC, risk of HBV reactivation, extrahepatic manifestations, risk of HBV transmission
+• CHB (with/without cirrhosis) → Start antiviral treatment if indicated, otherwise return to monitoring
+• HBsAg negative, anti-HBc positive → No specialist follow-up (inform about HBV reactivation risk). In case of immunosuppression: start oral antiviral prophylaxis or monitor
+----
+Page 7
+
+months, HBV DNA determinants every 6–12 months
+and assessment for liver fibrosis every 12 months.
+HBeAg‑negative patients with HBV DNA <2,000 IU/
+ml should have ALT determinations every 6–12 months
+and periodical HBV DNA and liver fibrosis assessments,
+every year. Determination of quantitative HBsAg
+levels can help in the decision for follow‑up frequency
+in these patients.[54] However, two studies with Saudi
+patients have shown that correlation of qHBsAg levels
+with liver fibrosis was poor in these patients, wherein
+qHBsAg levels demonstrated a poor association with
+histological findings. Overall, these studies have shown
+that predictability based on qHBsAg levels of 1000 IU
+was not supportive of fibrosis.[55,56]
+For HBeAg‑negative patients with HBV DNA≥2,000 IU/ml,
+ALT should be determined at least every 3 months for the
+first year and every 6 months thereafter. Assessments of
+HBV DNA and liver fibrosis by non‑invasive methods
+every year for at least 3 years should be considered. If they
+do not fulfill any treatment indication within the first 3 years
+of follow‑up, they should be followed for life, similar to all
+patients in this phase.
+Recommendations for monitoring of therapy of
+patients currently not treated
+• Patients with HBeAg-positive chronic HBV infection who are younger than
+30 years should be followed at least every 3-6 months (Grade B)
+• Patients with HBeAg-negative chronic HBV infection and serum HBV DNA
+<2,000 IU/ml should be followed every 6-12 months (Grade B)
+• Patients with HBeAg-negative chronic HBV infection and serum HBV
+DNA ≥2,000 IU/ml should be followed every 3 months for the first year and
+thereafter every 6 months (Grade D)
+Treatment of CHB
+Overall, the available NA therapies for HBV can be
+categorized into medications that have low barrier for
+resistance, including Lamivudine (LAM), Telbivudine (TBV)
+and Adefovir (ADV),[58] and medications that have high
+barrier for resistance, which include Entecavir (ETV),
+Tenofovir Disoproxil Fumarate (TDF) and Tenofovir
+Alafenamide (TAF).[59‑61]
+LAM is one of the first medications used to treat
+CHB. However, the use of LAM is associated with an
+unacceptably high rate of resistance, reaching 49% at
+3 years and 70% in 5 years.[58] ADV had a better resistance
+profile compared to LAM, with 11% and 29% resistance
+rate in 3 and 5 years, respectively.[58] But this rate is now
+considered too high when compared with the relatively
+new generation of nucleot(s)ide analogues.
+ETV is a potent guanosine analogue. First evaluated vs
+LAM, it showed an excellent efficacy and safety profile.[62]
+The virological response rate (defined as negative HBV
+DNA by PCR) approaches 100% over 5 years of its use,
+in both HBeAg‑negative and HBeAg‑positive patients.[59]
+ETV has a high barrier for resistance, where after 5 years
+of its use, only 1% had emergence of resistance.[63]
+TDF is a prodrug of tenofovir which is a nucleotide
+inhibitor that acts on both hepatitis B and HIV.[58] Similar to
+ETV, TDF has an excellent efficacy profile. A retrospective
+cohort study of treatment‑naive CHB patients who
+were treated with TDF or ETV showed that both were
+effective in achieving complete viral response and had a
+favorable safety profile.[64] After seven years of treatment
+with TDF, 99.3% of patients achieved and maintained
+virological response.[58] Treatment with TDF did not result
+in detectable resistance after 8 years of treatment.[65]
+Due to the side-effect profile, difficulty of use, and the
+presence of better alternatives, the use of "conventional
+interferon" is not recommended, and peglated interferon
+should be used instead.[1,36] Since the release of the last
+guidelines in 2014, the concept of futility "endpoint" or
+the "stopping rule" when treating hepatitis B with peglated
+interferon has been introduced.[1,36,66]
+The importance of pretreatment predictors of response
+has been highlighted previously. The new evidence of
+stopping treatment with interferon is of great importance
+due to its side‑effect profile, and the excellent predictive
+value for those parameters on treatment outcomes,
+which are dependent on serum HBsAg levels.[67] In
+HBeAg‑positive patients, the lack of decline in qHBsAg
+levels (in genotypes A and D) or maintaining qHBsAg levels
+to more than 20,000 (in genotypes B and C) is a strong
+predictor of failure of treatment, with a negative predictive
+value of 92 to 100% for HBeAg seroconversion.[67] In
+HBeAg‑negative patients, the data is not as robust as is with
+HBeAg‑positive patients,[53] with most of the evidence on
+genotype D.[68,69] Overall, patients who have no decline in
+qHBsAg levels and have no decrease in HBV DNA level
+by 2‑log, will have very low chance of sustained treatment
+response, defined by HBV DNA level less than 2000 IU/
+mL after the end of treatment.[54]
+TAF is another NA that acts by inhibiting reverse
+transcription of the pregenomic RNA to HBV DNA.
+Compared with TDF, it has higher plasma stability and
+thus less accumulation in bone and kidney tissue. In
+both HBeAg‑positive and HBeAg‑negative patients, TAF
+achieved non‑inferiority to TDF in terms of efficacy
+of suppressing the viral load.[70,71] For HBeAg‑positive
+patients, 873 were assigned randomly to either TAF or
+----
+
+Page 8 :
+
+TDF in a 2:1 design. Sixty four percent of the patients
+achieved virological response in the TAF group compared
+to 67% in TDF group, after 48 weeks of treatment,
+which met the definition of non‑inferiority.[70] The results
+from HBeAg‑negative study comparing TAF to TDF
+were similar. A total of 426 patients randomized in a
+2:1 distribution between TAF and TDF, the virological
+response was 94% and 93% respectively between the
+two groups at 48 weeks.[71] Long‑term study on the same
+cohort was used for the aforementioned two trials of
+TAF approval. Patients were analyzed after 96 weeks from
+starting treatment. In the HBeAg‑positive patients group
+the response rate was similar between TAF and TDF (73%
+and 75% respectively). This was also demonstrated in the
+HBeAg‑negative group, with TAF and TDF having an
+insignificant difference in virological response (90% and
+91%, respectively).
+
+## CLINICAL RECOMMENDATIONS BOX
+### Treatment Recommendations
+| **Recommendation** | **Grade** |
+|-------------------|-----------||
+| The treatment of choice is the long-term administration of a potent NA with a high barrier to resistance, regardless of the severity of liver disease | **Grade A** |
+| Preferred regimens are ETV, TDF and TAF as monotherapies | **Grade A** |
+| LAM, ADV and TBV are not recommended in the treatment of CHB | **Grade A** |
+
+TREATMENT OF HBV IN SPECIAL POPULATIONS
+HBV‑HCV coinfection
+Early studies, after the introduction of direct antiviral
+therapy (DAA) for the treatment of HCV, reported HBV
+reactivation after initiation of DAA.[83] Based on these
+studies, the US Food and Drug Administration issued a
+warning about the risk of HBV reactivation. However,
+subsequent studies showed that the risk of reactivation
+is very low for patients with chronic or past infection
+with HBV.[84] Patients who meet the criteria for HBV
+treatment should be treated concurrently or before
+initiation of DAA. HBV DNA and ALT should be
+monitored every four to eight weeks while on DAA and
+three months after completion of therapy. Patients with
+positive HBsAg who do not meet the criteria for HBV
+treatment should be monitored closely while on DAA.
+We recommend ALT level monitoring every four weeks
+while on DAA for patients who are HBsAg‑negative
+but HBcAb‑positive. If ALT starts to rise, HBsAg and
+
+----
+
+Page 9:
+
+HBV DNA must be obtained to determine the need to
+start HBV treatment.
+Recommendations
+• Treatment of HCV through DAAs may lead to reactivation of HBV. Patients
+who meet the criteria for HBV treatment should be treated concurrently or
+before initiation of DAA (Grade A)
+• HBV DNA and ALT should be monitored every four to eight weeks while on
+DAA and three months after completion of therapy (Grade D)
+• ALT level should be monitored every four weeks while on DAA for patients
+who are HBsAg-negative but HBcAb-positive. If ALT starts to rise, HBsAg
+and HBV DNA must be obtained to determine the need to start HBV
+treatment (Grade D).
+
+## CLINICAL RECOMMENDATIONS BOX
+### Recommendations
+• All HIV-positive patients with HBV co-infection should start ART irrespective
+of CD4 cell count (Grade A)
+• HBV-HIV co-infected patients should be treated with TDF- or TAF-based
+ART regimen (Grade A)
+
+## CLINICAL RECOMMENDATIONS BOX
+### Recommendations
+• Prophylaxis for all patients with positive HBsAg should be done before
+initiating chemotherapy or other immunosuppressive agents (Grade A)
+• HBsAg-negative/anti-HBc-positive patients, should undergo HBV
+prophylaxis if they are candidates for anti CD20 or are undergoing stem
+cell transplantation. HBV prophylaxis should continue for at least six
+months after completion of immunosuppressive treatment and for twelve
+months if taking anti CD20 (Grade D).
+
+----
+page 10
+## CLINICAL RECOMMENDATIONS BOX
+### Recommendations
+• All pregnant women must be screened for HBV during the first trimester
+(Grade A)
+• All pregnant women with HBV DNA greater than 100,000 IU/mL in the late
+second trimester (between 24-28 weeks of gestation) should start antiviral
+prophylaxis with TDF, or TAF as an alternative (Grade D)
+• Switch to TDF or TAF is recommended if the patient is receiving ETV, ADV,
+or interferon during pregnancy (Grade D)
+• Breastfeeding is not contraindicated in HBsAg-positive untreated women
+or on TDF-based treatment or prophylaxis (Grade B)
+"""
 
 
 def assess_hbv_eligibility(patient_data: Dict[str, Any]) -> Dict[str, Any]:
     """
     Assess patient eligibility for HBV treatment based on SASLT 2021 guidelines
-    using retrieval from vector store and LLM analysis
+    using hardcoded guideline pages (3, 4, 6, 7, 8, 9, 10) and LLM analysis
     
     Args:
         patient_data: Dictionary containing patient clinical parameters
@@ -157,39 +401,8 @@ def assess_hbv_eligibility(patient_data: Dict[str, Any]) -> Dict[str, Any]:
                 "recommendations": "Patient is HBsAg negative. HBV treatment is not indicated. HBsAg positivity is required for HBV treatment consideration according to SASLT 2021 guidelines."
             }
         
-        # Create search query based on patient parameters
-        search_query = create_patient_query(patient_data)
-        logger.info(f"Generated search query: {search_query}")
-        
-        # Retrieve relevant guidelines from vector store
-        docs = hybrid_search(search_query, provider="SASLT", k_vector=8, k_bm25=2)
-        
-        if not docs:
-            logger.warning("No documents retrieved from vector store")
-            return {
-                "eligible": False,
-                "recommendations": "Unable to retrieve SASLT 2021 guidelines. Please try again."
-            }
-        
-        # Log retrieved documents
-        logger.info(f"\n{'='*80}")
-        logger.info(f"RETRIEVED DOCUMENTS ({len(docs)} documents)")
-        logger.info(f"{'='*80}")
-        for i, doc in enumerate(docs, 1):
-            source = doc.metadata.get('source', 'Unknown')
-            page = doc.metadata.get('page_number', 'N/A')
-            content_preview = doc.page_content[:200] + "..." if len(doc.page_content) > 200 else doc.page_content
-            logger.info(f"\n📄 Document {i}:")
-            logger.info(f"   Source: {source}")
-            logger.info(f"   Page: {page}")
-            logger.info(f"   Content Preview: {content_preview}")
-        logger.info(f"{'='*80}\n")
-        
-        # Format retrieved documents for LLM
-        context = "\n\n".join([
-            f"[Source: {doc.metadata.get('source', 'Unknown')}, Page: {doc.metadata.get('page_number', 'N/A')}]\n{doc.page_content}"
-            for doc in docs
-        ])
+        # Use hardcoded SASLT 2021 guidelines instead of RAG retrieval
+        logger.info("Using hardcoded SASLT 2021 guidelines (Pages 3, 4, 6, 7, 8, 9, 10)")
         
         # Define ALT ULN for context
         sex = patient_data.get("sex", "Male")
@@ -213,7 +426,6 @@ def assess_hbv_eligibility(patient_data: Dict[str, Any]) -> Dict[str, Any]:
         
         # Create prompt for LLM to analyze patient against guidelines
         analysis_prompt = f"""You are an HBV treatment eligibility assessment system. Analyze the patient data against SASLT 2021 guidelines.
-
 PATIENT DATA:
 - Sex: {sex}
 - Age: {age} years
@@ -231,40 +443,20 @@ PATIENT DATA:
 - Family History (Cirrhosis/HCC): {family_history}
 - Other Comorbidities: {', '.join(comorbidities) if comorbidities else 'None'}
 
-HBV ELIGIBILITY CRITERIA & TREATMENT OPTIONS – SASLT 2021:
-
-TREATMENT ELIGIBILITY CRITERIA:
-1. HBV DNA > 2,000 IU/mL, ALT > ULN, regardless of HBeAg status, and/or at least moderate liver necroinflammation or fibrosis (Grade A)
-2. Patients with cirrhosis (compensated or decompensated), with any detectable HBV DNA level and regardless of ALT levels (Grade A)
-3. HBV DNA > 20,000 IU/mL and ALT > 2xULN, regardless of the degree of fibrosis (Grade B)
-4. 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)
-5. 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)
-
-TREATMENT CHOICES:
-- Preferred regimens are ETV (entecavir), TDF (tenofovir disoproxil fumarate), and TAF (tenofovir alafenamide) as monotherapies (Grade A)
-
-MANAGEMENT ALGORITHM:
-• HBsAg positive with chronic HBV infection and no signs of chronic hepatitis → Monitor (HBsAg, HBeAg, HBV DNA, ALT, fibrosis assessment). Consider: risk of HCC, risk of HBV reactivation, extrahepatic manifestations, risk of HBV transmission
-• CHB (with/without cirrhosis) → Start antiviral treatment if indicated, otherwise return to monitoring
-• HBsAg negative, anti-HBc positive → No specialist follow-up (inform about HBV reactivation risk). In case of immunosuppression: start oral antiviral prophylaxis or monitor
 
 SASLT 2021 GUIDELINES (Retrieved Context):
-{context}
-
+{SASLT_GUIDELINES}
 Based STRICTLY on the SASLT 2021 guidelines and criteria provided above, assess this patient's eligibility for HBV antiviral treatment.
-
 You MUST respond with a valid JSON object in this exact format:
 {{
   "eligible": true or false,
   "recommendations": "Comprehensive assessment with inline citations"
 }}
-
 IMPORTANT JSON FORMATTING:
 - Return ONLY valid JSON without markdown code blocks
 - Use spaces instead of literal newlines within the "recommendations" string
 - Separate paragraphs with double spaces or use \\n for line breaks
 - Do NOT include literal newline characters in the JSON string values
-
 CRITICAL CITATION REQUIREMENTS:
 1. The "recommendations" field must be a comprehensive narrative that includes:
    - Eligibility determination with rationale
@@ -273,7 +465,6 @@ CRITICAL CITATION REQUIREMENTS:
    - Special considerations (pregnancy, immunosuppression, coinfections, etc.)
    - Any additional clinical notes
    - **References** section at the end listing all cited pages
-
 2. EVERY statement in recommendations MUST include inline citations in this format:
    "[SASLT 2021, Page X]" where X is the specific page number
    
@@ -283,13 +474,9 @@ CRITICAL CITATION REQUIREMENTS:
    **References**
    SASLT 2021 Guidelines - Pages: 12, 15, 18
    (Treatment Eligibility Criteria, First-Line Antiviral Agents, Monitoring Protocols)"
-
 4. ALWAYS cite the specific page number from the [Source: ..., Page: X] markers in the guidelines above
-
 5. Include evidence grade (Grade A, B, C, D) when available in the guidelines
-
 6. END the recommendations with a **References** section that lists all cited pages in ascending order with brief description of topics covered
-
 IMPORTANT:
 1. Base your assessment ONLY on the SASLT 2021 guidelines provided
 2. Make recommendations comprehensive and detailed
@@ -299,6 +486,7 @@ IMPORTANT:
 6. Return ONLY the JSON object, no additional text
 """
         
+        
         # Log the complete prompt being sent to LLM
         logger.info(f"\n{'='*80}")
         logger.info(f"LLM PROMPT")