Hepatitis B virus (HBV) infection remains a global public health problem with changing
epidemiology due to several factors including vaccination policies and migration.
This Clinical Practice Guideline presents updated recommendations for the optimal
management of HBV infection. Chronic HBV infection can be classified into five phases:
(I) HBeAg-positive chronic infection, (II) HBeAg-positive chronic hepatitis, (III)
HBeAg-negative chronic infection, (IV) HBeAg-negative chronic hepatitis and (V) HBsAg-negative
phase. All patients with chronic HBV infection are at increased risk of progression
to cirrhosis and hepatocellular carcinoma (HCC), depending on host and viral factors.
The main goal of therapy is to improve survival and quality of life by preventing
disease progression, and consequently HCC development. The induction of long-term
suppression of HBV replication represents the main endpoint of current treatment strategies,
while HBsAg loss is an optimal endpoint. The typical indication for treatment requires
HBV DNA >2,000IU/ml, elevated ALT and/or at least moderate histological lesions, while
all cirrhotic patients with detectable HBV DNA should be treated. Additional indications
include the prevention of mother to child transmission in pregnant women with high
viremia and prevention of HBV reactivation in patients requiring immunosuppression
or chemotherapy. The long-term administration of a potent nucleos(t)ide analogue with
high barrier to resistance, i.e., entecavir, tenofovir disoproxil or tenofovir alafenamide,
represents the treatment of choice. Pegylated interferon-alfa treatment can also be
considered in mild to moderate chronic hepatitis B patients. Combination therapies
are not generally recommended. All treated and untreated patients should be monitored
for treatment response and adherence, and the risk of progression and development
of complications. HCC remains the major concern for treated chronic hepatitis B patients.
Several subgroups of patients with HBV infection require specific focus. Future treatment
strategies to achieve 'cure' of disease and new biomarkers are discussed.