Chronic hepatitis B in 2025: diagnosis, treatment and future directions

Chronic hepatitis B (CHB) is a leading cause of cirrhosis and hepatocellular carcinoma (HCC), with many patients remaining undiagnosed or undertreated despite effective vaccination and antiviral therapy. The 2025 European Association for the Study of the Liver (EASL) guidelines mark a shift towards biomarker-led, finite and personalised therapy, aiming for functional cure as sustained HBsAg loss. This review outlines updated recommendations on diagnosis, staging, treatment initiation and cessation, along with surveillance. Accurate interpretation of hepatitis B serological and virological markers remains central, with novel biomarkers, including quantitative HBsAg, HBcrAg and HBV RNA, enhancing disease stratification, guiding therapy and informing safe discontinuation of nucleos(t)ide analogues (NAs). The guidelines also emphasise the role of metabolic comorbidities, such as metabolic dysfunction-associated steatotic liver disease (MASLD), in accelerating fibrosis and increasing HCC risk. We summarise first-line NA and pegylated interferon options, monitoring requirements and surveillance strategies, highlighting common pitfalls such as under-recognition of at-risk patients with low viral load. Special considerations for pregnancy, immunosuppression and co-infections are addressed. Emerging therapies including RNA interference, core protein modulators and immunotherapeutics offer hope for finite, curative regimens. This article provides a practical, evidence-based guide for clinicians, trainees and allied health professionals to apply evolving recommendations in everyday practice.