Evolving Strategies in HBV Management: Insights From Updated International Guidelines

Recent updates to the international guidelines for chronic hepatitis B virus (HBV) infection reflect evolving concepts in disease monitoring and antiviral treatment strategies. The 2024-2025 guidelines from the World Health Organization (WHO), the European Association for the Study of the Liver (EASL), and the American Association for the Study of Liver Diseases (AASLD) incorporate new evidence on treatment eligibility, biomarkers, and long-term management of nucleos(t)ide analogue (NA) therapy. A key shift across these guidelines is the expansion of treatment eligibility beyond traditional alanine aminotransferase and HBV DNA thresholds, with increasing emphasis on fibrosis stage, age, and risk-based assessment. Emerging viral biomarkers-including quantitative HBsAg, HBV RNA, and HBcrAg-are also gaining attention as tools to refine disease stratification and guide treatment decisions, although their recommended roles vary among guidelines. Another area of evolving practice involves the concept of finite NA therapy. Although long-term antiviral therapy remains the standard approach, selected patients may be considered for treatment withdrawal under careful monitoring. However, recommendations differ substantially across guidelines, with WHO adopting a more conservative position, whereas EASL and AASLD allow individualized consideration of treatment discontinuation in selected noncirrhotic patients. Overall, these updated guidelines highlight both areas of convergence and ongoing controversy in HBV management. Understanding these differences is essential for clinicians to interpret guideline recommendations in the context of local practice settings and to guide future research aimed at achieving functional cure.