Guideline Update: Practice Guideline of Treatment of Chronic Hepatitis B-Practice Guideline of Chronic Hepatitis B

Video Transcription

Video Summary

In this interview, Dr. Nora Turow discusses the updated 2025 AASLD guidelines on chronic hepatitis B treatment. The goals focus on reducing liver disease morbidity and mortality and preventing new infections. The guidelines clarify hepatitis B phases—immune active, inactive, and indeterminate—and emphasize treatment considerations, especially for the indeterminate group based on age, fibrosis, and ALT levels. Key updates include antiviral treatment during pregnancy with TDF or TAF starting at week 28, earlier therapy in high viral load cases, and recommendations on using treatment to prevent horizontal transmission in high-risk scenarios. For immune tolerant patients, treatment is now advised for those over 40 or with liver inflammation/fibrosis, with shared decision-making for others. Stopping therapy is recommended only after surface antigen loss, with strict monitoring if discontinued. The guidelines address HCC surveillance post-surface antigen loss based on age and cirrhosis status. Vaccination remains a cornerstone for elimination, with expanded adult vaccination recommendations to fill coverage gaps globally.

Keywords

2025 AASLD guidelines

chronic hepatitis B treatment

hepatitis B phases

antiviral therapy pregnancy

immune tolerant patients treatment

hepatitis B vaccination