From the Guidelines
Chronic hepatitis B core infection should be treated with antiviral therapy to prevent the development of hepatocellular carcinoma, regardless of the phase of infection or viral load, as suggested by the most recent study in 2025 1.
Key Considerations
- The goal of treatment is to reduce the incidence of new infections, progressive liver disease, and risk of hepatocellular carcinoma by suppressing viral replication.
- First-line treatments include entecavir, tenofovir disoproxil fumarate, or tenofovir alafenamide, which are typically taken long-term, often indefinitely.
- Regular monitoring every 3-6 months is essential to assess treatment response, including liver function tests, HBV DNA levels, and HBeAg/anti-HBe status.
Treatment Approach
- The treatment approach should be based on the most recent guidelines and evidence, which suggest that antiviral therapy should be initiated promptly in all patients with chronic HBV infection, regardless of the phase of infection or viral load 1.
- The choice of antiviral medication should be based on the patient's individual needs and medical history, as well as the potential for resistance and side effects.
Monitoring and Follow-up
- Regular monitoring is essential to assess treatment response and adjust the treatment plan as needed.
- Patients should be monitored for risk of disease progression and hepatocellular carcinoma, and treated patients should be monitored for therapy response and adherence.
Recent Guidelines
- The most recent study in 2025 1 suggests that current frameworks for antiviral treatment should be simplified and expanded to reduce the incidence of new infections, progressive liver disease, and risk of hepatocellular carcinoma.
- The European Association for the Study of the Liver (EASL) guidelines from 2017 1 also provide recommendations for the management of HBV infection, including treatment indications and monitoring strategies.
From the Research
Chronic Hepatitis B Core Treatment
- The goal of antiviral therapy in patients with chronic hepatitis B is to prevent cirrhosis and hepatocellular carcinoma through persistent suppression of HBV replication 2.
- Ideal candidates for treatment are hepatitis B e antigen-positive patients with a prolonged phase of immune clearance and hepatitis B e antigen-negative patients with elevated levels of serum HBV DNA, abnormal alanine aminotransferase, and histologic evidence of moderate or severe liver necroinflammation and/or fibrosis 2.
- Patients with compensated or decompensated cirrhosis should be treated, even if alanine aminotransferase levels are normal and/or serum HBV DNA levels are low, in order to prevent disease flare and to improve liver function 2.
Available Treatment Options
- Seven drugs are available for the treatment of chronic hepatitis B: IFN-alpha, pegylated interferon, lamivudine, adefovir dipivoxil, entecavir, telbivudine, and tenofovir 2.
- Nucleos(t)ide analogues (NAs) are used in most HBeAg-positive chronic hepatitis B patients due to their oral administration, minimal risk of long-term resistance, and excellent tolerance and safety profile 3.
- Entecavir and tenofovir are recommended as first-line monotherapies for chronic hepatitis B due to their potent antiviral action and high genetic barrier to resistance 4, 5.
Treatment Guidelines
- Antiviral treatment should be initiated in patients with CHB who have a high risk of liver-related morbidity and who are likely to respond to treatment 6.
- Treatment should be initiated with one of the recommended first-line therapies (pegylated interferon-α, entecavir, or tenofovir), and treatment efficacy should be monitored regularly for serum HBV DNA, alanine aminotransferase, and serologic responses 6.
- Patients who are not immediately considered for treatment should be monitored and started on antiviral therapy in case of disease progression 6.