Hepatology April 2026
 
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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.

Comment on AASLD ISDA Practice Guideline on treatment of chronic hepatitis B (2025 Update)
 
Hepatology april 2026
 
In contrast to these international documents, the AASLD Practice Guideline continues to endorse the use of HBeAg serostatus, different HBV DNA levels to indicate treatment eligibility in HBeAg-positive (≥20,000 IU/mL) versus HBeAg-negative (≥2000 IU/mL) CHB, and a multi-tiered approach to interpretation of ALT elevation (ALT2x ULN), acknowledging the ease of access to laboratory testing in the United States compared with low and middle-income countries. As a consequence, AASLD retains the definitions of immune-tolerant, immune-active, inactive, as well as indeterminate phase (also known as the "gray zone") for CHB. In contrast, WHO and EASL promote a simplified nomenclature for clinical practice.6,7 At the same time, EASL has separately proposed a more detailed nomenclature for research purposes.6 Harmonization of terminology across guidelines would be desirable in the future to reduce confusion among clinicians and facilitate global alignment of treatment algorithms.9
 
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Visual Brief
 
Updated AASLD Guidelines for Chronic Hepatitis B Treatment
 
Hepatology April 26
 
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