The Management of Chronic Hepatitis B: 2025 Guidelines Update from the Canadian Association for the Study of the Liver and Association of Medical Microbiology and Infectious Disease Canada

Abstract

Chronic hepatitis B virus (HBV) infection poses significant public health challenges in Canada, particularly among newcomers from regions with high HBV prevalence. In alignment with the World Health Organization's goal of HBV elimination by 2030, this 2025 guidelines update-developed jointly by the Canadian Association for the Study of the Liver (CASL) and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada-presents recommendations for universal adult HBV screening, vaccination, laboratory assessment, and treatment. These guidelines emphasize patient-centred care, early diagnosis, and expanded antiviral treatment, including for individuals in the indeterminate or grey zone and special populations such as pregnant individuals, children, and those coinfected with HIV, hepatitis C, or hepatitis D. Notably, the guidelines recommend reflex HDV testing and routine use of quantitative HBsAg to support management decisions. These evidence-based recommendations are informed by expert consensus, recent literature, and international standards, with the aim of improving outcomes, reducing stigma, and informing future policy and research priorities.

Keywords: Association of Medical Microbiology and Infectious Disease (AMMI) Canada; Canadian Association for the Study of the Liver (CASL); guidelines; hepatitis B; update.

Figure 1. Summary of Recommendations for Hepatitis B Treatment Initiation

ALT = Alanine transaminase; F = Female; HBeAg = Hepatitis B e antigen; HBsAg = Hepatitis B surface antigen; HBV = Hepatitis B virus; HCC = Hepatocellular carcinoma; M = Male