Hepatitis B
Also known as: chronic hepatitis B · HBV
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AASLD/IDSA Practice Guideline Update on Treatment of Chronic Hepatitis B
AASLD / IDSA · 2025 · 2025 update
A joint AASLD and IDSA guideline giving updated recommendations on prevention, surveillance and antiviral treatment of chronic hepatitis B, developed using GRADE methodology around six key clinical questions.
- The update addresses prevention of mother-to-child transmission, treatment in immune-tolerant and indeterminate phases, treatment discontinuation, and hepatocellular carcinoma surveillance. source
- It is presented as an update that supersedes the societies' earlier recommendations on chronic hepatitis B. source
EASL Clinical Practice Guidelines on the management of hepatitis B virus infection
EASL (European Association for the Study of the Liver) · 2025
EASL's current guideline on chronic hepatitis B virus infection, covering diagnosis, treatment goals and indications, therapeutic options, surveillance and special populations.
US vs EU key differences
- The ALT reference range used for treatment decisions differs: the 2025 AASLD/IDSA guideline applies sex-specific upper limits of normal (35 U/L for men, 25 U/L for women), whereas the 2025 EASL guideline uses 40 U/L for both sexes. source
- The 2025 AASLD/IDSA update widens treatment eligibility beyond classic immune-active disease, conditionally suggesting antivirals for immune-tolerant patients over about age 40 or with grade 2 inflammation or F2 fibrosis, and for indeterminate 'grey zone' patients via shared decision-making. source
- Stopping rules differ in emphasis: the US guideline conditionally recommends against discontinuing nucleos(t)ide analogue therapy until HBsAg loss, while the EASL guideline sets out a dedicated algorithm for stopping nucleos(t)ide treatment in selected patients. source
- Version currency is unusually well matched here: both the US and the European hepatitis B guidelines were refreshed in 2025. source
What changed recently
- US2018 → 2025 update2025-11-01
The 2025 AASLD/IDSA guideline tackles six GRADE-based questions the 2018 guidance left unresolved, including whether to treat HBsAg-positive people in the immune-tolerant and indeterminate phases, when to withdraw antiviral therapy, and HCC surveillance in HBV coinfection and after HBsAg loss. Recommendations from 2018 that were not revisited remain in force, and an integrated algorithm combines old and new guidance.
source ↗curation confidence 90% - EU2017 → 20252025-05-10
EASL's 2025 hepatitis B guideline shifts from indefinite viral suppression toward personalised, finite therapy with functional cure (sustained HBsAg loss) as the goal. Newer biomarkers including quantitative HBsAg, HBcrAg and HBV RNA are built into disease staging, treatment selection and decisions about safely stopping antivirals.
source ↗curation confidence 90%
See the full update feed for changes across every system.