Facebook X-twitter Instagram Youtube

Same Virus, Different Rules?

With new hepatitis B guidelines rolling out across societies, leading experts, clinicians, and community advocates came together on 9th November 2025 at AASLD 2025 to ask, ‘How do we align them for real-world care and ensure communities are part of the solution?’

The introduction set the stage to discuss how guidelines affect real-world care and the many challenges that patients face to access care, particularly in low resource and community-based settings. This was followed by short highlights of each of the guidelines and statements presented by a member of each of the writing groups. The meeting focused on hepatitis B guidelines from China (2023), World Health Organization (2024), European Association for the Study of Liver disease (2025) and American Association for the Study of Liver Disease (2025) along with community statements from World Hepatitis Alliance (2024) and Hepatitis B Foundation (2024).

 

Key features of each guideline and community statements:

  • Chinese guidelines use presence of viremia without an HBV DNA threshold, combined with age of 30 and other risk factors and comorbidities.
  • WHO guidelines have eligibility criteria that are non-lab based for areas without access to HBV DNA, including comorbidities such as diabetes and MASLD. There is a section on simplified service delivery
  • EASL clinical practice guidelines state that in theory, anybody who is HBsAg+ is a candidate for therapy. The goals of treatment include improvement of patient reported outcome and health related quality of life.
  • AASLD guidelines incorporate shared decision making for treatment to prevent horizontal transmission, people in immune tolerant and indeterminate phases.
  • The World Hepatitis Alliance “Treat All” piece emphasizes the importance for treatment is accessible to all, the importance of equity and that treatment guidelines respond to the needs of people living with the virus.
  • The Hepatitis B Foundation position statement is aimed to promote the delivery of patient centred care, simplify and help close current gaps in treatment and ultimately achieve hepatitis B elimination equitably.

 

Following the presentations, there was an engaging discussion amongst the about 20 attendees. They brought up the many challenges to accessing and delivering care and the unique needs of various communities in the US and globally. The importance of simplifying guidelines came up repeatedly with the goal of enabling primary care providers to be able to take on hepatitis B care and treatment.

One major question posed was the global messaging about having many guidelines with different treatment thresholds and approaches. Given the potential confusion that may arise, the need to align guidelines in some way or communicate some shared principles came up. While there are variations in age in the guidelines and other differences, it is appreciated that all the guidelines expand treatment and allow for earlier treatment. Regional differences in disease are important to acknowledge especially in high burdened areas such as Asia and Sub-Saharan Africa.

The meeting concluded with a consensus that although the guidelines do differ in detail, there is also shared ground. Next steps would be to consider creating a shared statement that focuses on areas of alignment.

This conversation will be continuing at the World Hepatitis Summit 2026. Register your interest here – Register – World Hepatitis Summit 2026