[Expert recommendations on the first-line use and optimization plan of nucleos(t)ide analogues in the context of...

Novel therapeutic approaches aimed at achieving a functional cure for chronic hepatitis B have become a hot topic of academic research. However, the optimal timing of antiviral therapy and selection of nucleos(t)ide analogues (NAs) for different patient populations with chronic HBV infection remain unclear in the context of clinics. Based on current guidelines and available clinical evidence, expert recommendations have been developed with a focus on the timing of antiviral therapy and strategies for optimizing NA treatment before novel therapies aimed at achieving a functional cure become clinically accessible: (1) Patient populations with chronic hepatitis B who may benefit from novel therapies aimed at achieving a functional cure include those with hepatitis B surface antigen (HBsAg) ≤3,000 IU/mL, HBV DNA <90 or 100 IU/mL, and alanine aminotransferase (ALT) ≤2× the upper limit of normal (ULN). (2) For HBV DNA-positive patients aged 18-30 with chronic HBV infection, antiviral therapy should be initiated early to maximize the reduction of risks for conditions such as cirrhosis and hepatocellular carcinoma associated with advanced aging. (3) For patients who are not expected to benefit from novel therapies aimed at achieving a functional cure, early initiation of NA therapy is recommended to promote their transition into a population that may benefit from it. (4) After a functional cure has been achieved, HBV infection status should be reevaluated before administering medications that have a risk of HBV reactivation to determine whether prophylactic NA therapy is needed.