MG Ghany et al. Hepatology 83(4):p 974-997, April 2026. Open Access! AASLD IDSA Practice Guideline on treatment of chronic hepatitis B

Yesterdays’ blog post summarized the 6 key questions that are reviewed in the updated guidelines. Today’s post provides more details on treatment and a direct link to the practice guideline.

Background: “CHB affects ~258 million individuals (2022) globally⁸ and leads to an estimated 1.1 million deaths annually due to complications of cirrhosis and HCC…This guideline focuses on six specific issues related to management of CHB. Other recommendations for management of CHB addressed in the 2018 guidelines will continue to be applicable and the reader is referred to this document.¹“

Treatment Recommendations for Patients without Cirrhosis Based on HBeAg Results, HBV DNA and ALT Values

AASLD guidelines favor continuing nucleos(t)ide analogs (NAs) therapy until loss of HBsAg. However, there are additional criteria in new the guidelines for shared decision-making on stopping therapy in those with very low HBsAg levels (<100 IU/mL).

Criteria for stopping NA therapy if ALL are met:

Criteria for resuming therapy immediately (need only 1)

Other Criteria for resuming therapy

Related blog posts:

• Is It Time to Revise Hepatitis B Treatment Guidelines? (2023)
• Comprehensive 2018 AASLD Guidance for Chronic Hepatitis B (2018)
• Scientific Basis for Current Hepatitis B Vaccine Strategy (2025)

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