AASLD ISDA Practice Guideline on treatment of chronic hepatitis B

Marc G Ghany¹, Calvin Q Pan², Anna S Lok³, Jordan J Feld⁴, Joseph K Lim⁵, Su H Wang^{6

7

8}, Arthur Y Kim^{9

10}, Amy S Tang¹¹, Mindie H Nguyen^{12

13

14}, Susanna Naggie¹⁵, Mark S Sulkowski¹⁶, Rodriguez-Baez Norberto¹⁷, Jacki Chen^{18

19}, M Hassan Murad^{20

21}, Khaled S Mohammad^{21

22}, Norah A Terrault²³

Affiliations

¹ Clinical Hepatology Research Section, Liver Diseases Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
² Division of Gastroenterology and Hepatology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, USA.
³ Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
⁴ Toronto Centre for Liver Disease, University Health Network, Canada.
⁵ Section of Digestive Diseases and Yale Liver Center, Yale University School of Medicine, New Haven, CT, USA.
⁶ Center for Asian Health at Cooperman Barnabas Medical Center, Florham Park, NJ, USA.
⁷ Rutgers New Jersey Medical School, Newark, NJ, USA.
⁸ Rutgers Institute for Health, Health Care Policy and Aging Research (IFH), New Brunswick, NJ, USA.
⁹ Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Department of Medicine, Harvard Medical School, Boston, MA, USA.
¹¹ North East Medical Services, San Francisco, CA, USA.
¹² Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
¹³ Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA.
¹⁴ Stanford Cancer Institute, Stanford University Medical Center, Palo Alto, CA, USA.
¹⁵ Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
¹⁶ Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁷ Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁸ Taiwan Hepatitis Information & Care Association (THICA), Princeton, NJ, USA.
¹⁹ Rutgers Health, Robert Wood Johnson Medical School, Piscataway, NJ, USA.
²⁰ Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA.
²¹ Preventive Medicine, Mayo Clinic, Rochester, MN, USA.
²² Division of Community Pediatric and Adolescent Medicine, Mayo Clinic Children's, Rochester, MN, USA.
²³ Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

PMID: 41186418
DOI: 10.1097/HEP.0000000000001549

Practice Guideline

AASLD ISDA Practice Guideline on treatment of chronic hepatitis B

Marc G Ghany et al. Hepatology. 2026.

. 2026 Apr 1;83(4):974-997.

doi: 10.1097/HEP.0000000000001549. Epub 2025 Nov 4.

Authors

Affiliations

¹ Clinical Hepatology Research Section, Liver Diseases Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
² Division of Gastroenterology and Hepatology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, USA.
³ Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
⁴ Toronto Centre for Liver Disease, University Health Network, Canada.
⁵ Section of Digestive Diseases and Yale Liver Center, Yale University School of Medicine, New Haven, CT, USA.
⁶ Center for Asian Health at Cooperman Barnabas Medical Center, Florham Park, NJ, USA.
⁷ Rutgers New Jersey Medical School, Newark, NJ, USA.
⁸ Rutgers Institute for Health, Health Care Policy and Aging Research (IFH), New Brunswick, NJ, USA.
⁹ Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Department of Medicine, Harvard Medical School, Boston, MA, USA.
¹¹ North East Medical Services, San Francisco, CA, USA.
¹² Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
¹³ Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA.
¹⁴ Stanford Cancer Institute, Stanford University Medical Center, Palo Alto, CA, USA.
¹⁵ Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
¹⁶ Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁷ Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁸ Taiwan Hepatitis Information & Care Association (THICA), Princeton, NJ, USA.
¹⁹ Rutgers Health, Robert Wood Johnson Medical School, Piscataway, NJ, USA.
²⁰ Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA.
²¹ Preventive Medicine, Mayo Clinic, Rochester, MN, USA.
²² Division of Community Pediatric and Adolescent Medicine, Mayo Clinic Children's, Rochester, MN, USA.
²³ Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

PMID: 41186418
DOI: 10.1097/HEP.0000000000001549

Abstract

Background and aims: Accumulating data related to prevention, surveillance and treatment of chronic hepatitis B (CHB) provided the impetus for this updated guideline, using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach.

Methods: The guideline was developed in compliance with the National Academy of Medicine standards. The guideline panel developed structured questions following the Population, Intervention Comparison, Outcomes (PICO) framework. The panel addressed 6 PICO questions covering prevention (maternal to infant transmission and horizontal transmission), surveillance for liver cancer (among hepatitis B surface antigen positive (HBsAg) persons co-infected with hepatitis C virus, hepatitis D virus and/or human immunodeficiency viruses and after HBsAg loss) and treatment (HBsAg positive persons in immune-tolerant or indeterminate phases as well as withdrawal of antiviral therapy), providing evidence-based recommendations on these topics. Four systematic reviews of the literature were conducted, and two existing systematic reviews were utilized to support the recommendations in this practice guideline.

Conclusions: This evidence-based guideline provides updated recommendations to optimize the care of persons with CHB.

Keywords: antiviral discontinuation; grey zone; hepatocellular carcinoma; horizontal transmission; immune-tolerant; indeterminate; pregnancy; surveillance.

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References

1. Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67:1560–1599.
1. Di Bisceglie AM, Lombardero M, Teckman J, Roberts L, Janssen HL, Belle SH, et al. Determination of hepatitis B phenotype using biochemical and serological markers. J Viral Hepat. 2017;24:320–329.
1. Huang DQ, Li X, Le MH, Le AK, Yeo YH, Trinh HN, et al. Natural History and Hepatocellular Carcinoma Risk in Untreated Chronic Hepatitis B Patients With Indeterminate Phase. Clin Gastroenterol Hepatol. 2022;20:1803–1812 e1805.
1. Yao K, Liu J, Wang J, Yan X, Xia J, Yang Y, et al. Distribution and clinical characteristics of patients with chronic hepatitis B virus infection in the grey zone. J Viral Hepat. 2021;28:1025–1033.
1. Sterling RK, Duarte-Rojo A, Patel K, Asrani SK, Alsawas M, Dranoff JA, et al. AASLD Practice Guideline on imaging-based noninvasive liver disease assessment of hepatic fibrosis and steatosis. Hepatology. 2025;81:672–724.

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AASLD ISDA Practice Guideline on treatment of chronic hepatitis B

Affiliations

AASLD ISDA Practice Guideline on treatment of chronic hepatitis B

Authors

Affiliations

Abstract

References

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MeSH terms

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LinkOut - more resources

Full Text Sources