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Clinical Guidelines

All children, teens and adults living with chronic hepatitis B infection should be monitored regularly since they are at increased risk for developing cirrhosis, liver failure, or liver cancer. Early detection of a serious liver problem increases one’s treatment options and improves long-term health outcomes.  In addition, all sexual partners and close family or household members should be tested for hepatitis B and vaccinated if needed.

Professional medical organizations have developed clinical practice guidelines to help doctors around the world manage and treat people living with hepatitis B. They include guidance for adults, pregnant women, children and those who are coinfected. We have compiled these guidelines to be used as a resource for people and to help guide discussions with your doctor. 

Clinical Guidelines for Adults

The standard recommendation for care is to schedule visits with a liver specialist (or a care provider knowledgeable about hepatitis B) every six months, but this can be more or less depending on your medical situation. During these check-ups, the following usually occurs to monitor your health and your liver:

  • Physical exam
  • Blood tests for hepatitis B markers 
  • Blood tests for liver enzymes 
  • Blood tests indicating liver function
  • Complete Blood Count (CBC)
  • Blood tests for liver cancer screening
  • Imaging studies of the liver 

*See the Blood Tests and Diagnosis for Hepatitis B section for specific test information. 

AASLD Update on Prevention, Diagnosis and Treatment of Chronic Hepatitis B (February 2018)

(APASL) Guidelines on the Management of Hepatitis B (November 2015)

EASL Clinical Practice Guidelines for Hepatitis B (2017) 

WHO Guidelines for the Prevention, Care and Treatment of Persons with Chronic Hepatitis B Infection (March 2015)

WHO Prevention of Mother-To-Child Transmission of Hepatitis B Virus: Guidelines on Antiviral Prophylaxis in Pregnancy (July 2020)

Hepatitis B Management: Guidance for the Primary Care Provider (2020)
            *Simplified guidance and algorithms for primary care providers on prevention, diagnosis and management of hepatitis B

Point of Care Toolkit for Hepatitis B Screening and Care (for Europe, 2020)

Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice From the American College of Physicians and the Centers for Disease Control and Prevention (2017)

 

Country-specific Guidelines

Some countries with a high prevalence of hepatitis have developed their own national guidelines for care and treatment.

Canada: Management of Hepatitis B Virus Infection: 2018 Guidelines from the Canadian Association for the Study of the Liver and Association of Medical Microbiology and Infectious Disease (2018)

Columbia: Diagnosis and Treatment of Chronic Hepatitis B in Columbia (2016) (Spanish)

Ghana: Republic of Ghana National Guidelines for Prevention, Care and Treatment of Viral Hepatitis (2016)

Nigeria: National Guidelines for the Prevention, Care and Treatment of Viral Hepatitis B and C in Nigeria (2016)

Portugal: National Program for Viral Hepatitis in Portugal (2017) (Portuguese)

Zambia: Implementation Framework & Clinical Guidance for Viral Hepatitis Prevention & Treatment (2019)

 

Guidelines for People with Cancer

ASCO Provisional Clinical Update Offers New Recommendations for HBV Management in Patients with Cancer

On July 27, 2020, the American Society of Clinical Oncology (ASCO) published provisional guidelines recommending that all people diagnosed with cancer be tested for hepatitis B before starting anticancer treatment. According to the ASCO statement, up to 90% of people diagnosed with cancer have at least one risk factor for hepatitis B. Cancer treatments can suppress the immune system and cause the virus to reactivate, which can lead to serious liver damage or liver failure. The guidelines discuss how to manage people undergoing cancer treatment who also have hepatitis B, to prevent viral flares.

 

Clinical Guidelines for Children with Chronic Hepatitis B

In general, the clinical guidelines for children are the same as for adults - visits are usually scheduled every six months or once a year. Most children do not need drug treatment, but they still need to be monitored regularly to make sure they remain healthy and to detect any problems with their liver as soon as possible. Visits will include a physical exam, blood tests, and possibly an imaging study of the liver (ultrasound, FibroScan [Transient Elastography] or CT scan).

AASLD guidelines provide guidance for treating children under the “Updated Recommendations on the Treatment of Patients With Chronic Hepatitis B”, section 9A. 

The Hepatitis B Foundation convened the first Pediatric HBV Workshop and invited the nation’s leading pediatric liver specialists to develop the first national recommendations for children living with hepatitis B to ensure that they receive the best care possible. These recommendations have been published in highly respected, peer-reviewed journals and provide expert guidance for the care of infected children.

Hepatitis B Foundation’s Clinical Guidelines for Pediatric HBV

HBF's Pediatric HBV Screening and Monitoring Recommendations
Published in Pediatrics in November 2009
Haber BA, Block JM, Jonas MM, Karpen SJ, London WT, McMahon BJ, Murray KF, Narkewicz MR, Rosenthal P, Schwarz KB. Recommendations for screening, monitoring, and referral of pediatric chronic hepatitis B. Pediatrics;124:e1007-13. (Nov. 2009)

HBF's Pediatric HBV Management and Treatment Recommendations
Published in Hepatology in October 2010
Jonas MM, Block JM, Haber BA, Karpen SJ, London WT, Murray KF, Narkewicz MR, Rosenthal P, Schwarz KB, and McMahon BJ (2010). Treatment of children with chronic hepatitis B virus infection in the United States: Patient selection and therapeutic options. Hepatology;52;2192-13. (Oct. 2010)


Additional Recommendations

Chronic Hepatitis B in Pregnancy: A Workshop Consensus on Screening, Evaluation, and Management, Part 1

Screening Recommendations for Hepatitis B

The role of primary care physician assistants in managing chronic hepatitis B

Chronic hepatitis B infection: A workshop consensus statement and algorithm

Internist Diagnosis and Management of Chronic Hepatitis B Virus Infection