EASL 2025 Hepatitis B Guidelines
I cannot provide you with the EASL 2025 guidelines because they have not been published yet. The most recent EASL guidelines for Hepatitis B management were published in 2017, not 2025. 1
Current EASL Guidelines (2017)
The EASL 2017 Clinical Practice Guidelines remain the most current official guidance from the European Association for the Study of the Liver for managing chronic hepatitis B virus infection. 1
Key Updates in EASL 2017 Guidelines
Phase Classification Changes:
- EASL introduced new nomenclature, renaming the "immune-tolerant phase" to "Phase 1 or HBeAg-positive chronic HBV infection" to better reflect the immunological understanding that true immune tolerance may not exist. 1
- This phase is characterized by high HBV DNA (>1 million IU/mL), normal ALT, positive HBeAg, minimal inflammation on histology, high HBV DNA integration, clonal hepatocyte expansion, and preserved HBV-specific T cell function until young adulthood. 1
Treatment Indications:
- All patients with cirrhosis and detectable HBV DNA should receive treatment regardless of ALT levels. 2, 3
- Treatment is recommended for patients with HBV DNA ≥2,000 IU/mL, elevated ALT, and/or at least moderate histological lesions. 2, 3
- Consider treatment in HBeAg-positive patients over age 30 regardless of ALT if other risk factors are present. 3
First-Line Therapy:
- Entecavir, tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide fumarate (TAF) are the preferred nucleos(t)ide analogues due to high potency and high genetic barrier to resistance. 2, 3
- First-generation NAs are not recommended due to low potency and high resistance rates. 2
- Pegylated interferon alfa (PegIFNα) remains an option for finite-duration therapy with the goal of inducing long-term immunological control, though response is variable and side effects limit its use. 1
Response Definitions:
- Virological response during NA therapy is defined as undetectable HBV DNA by sensitive PCR assay (limit of detection 10 IU/mL). 1, 2
- Sustained off-therapy virological response is defined as serum HBV DNA <2,000 IU/mL for at least 12 months after therapy ends. 1
Monitoring Recommendations:
- Patients not on treatment should have ALT determinations at least every 3 months, HBV DNA every 6-12 months, and fibrosis assessment every 12 months. 1
- During treatment, monitor liver function tests and HBV DNA every 3-6 months. 2, 3
Treatment Duration:
- Long-term, potentially indefinite treatment is typically required with NAs. 2
- HBsAg loss is considered the optimal endpoint but is rarely achieved. 2
- Stopping NA therapy may be considered in HBeAg-positive patients who achieve HBeAg seroconversion with undetectable HBV DNA and have completed at least 12 months of consolidation therapy. 2
Common Pitfalls
Do not rely solely on traditional laboratory ALT cutoffs to exclude necroinflammation and fibrosis—normal ALT by conventional criteria does not exclude significant liver disease. 1
Monitor renal function carefully in patients on TDF or adefovir, particularly those with pre-existing risk factors. 3
Recognize that current treatment guidelines may miss patients at risk for hepatocellular carcinoma and liver-related death—consider additional factors like baseline albumin ≤3.5 mg/dL, platelet count ≤130,000/mm³, and HBV mutations when making treatment decisions. 4
If you have access to EASL 2025 guidelines that were recently released, please share them, as they are not yet available in the medical literature or standard guideline repositories as of the current evidence base.