Chronic hepatitis B (CHB) remains a major cause of cirrhosis and hepatocellular carcinoma (HCC) worldwide, affecting over 250 million people. In the UK, the burden is concentrated in migrant populations, yet diagnosis and treatment rates remain low. The 2025 European Association for the Study of the Liver guidelines mark a paradigm shift towards biomarker-led, personalised care, incorporating metabolic risk factors and focusing on functional cure, defined as sustained hepatitis B surface antigen (HBsAg) loss and undetectable hepatitis B virus (HBV) DNA. This review summarises key updates in diagnosis, staging, treatment initiation and cessation. The revised framework emphasises early treatment to prevent fibrosis progression and HCC, particularly in patients with metabolic dysfunction-associated steatotic liver disease, where disease progression can occur despite low viral load or normal alanine aminotransferase. Novel biomarkers, including quantitative HBsAg, hepatitis B core-related antigen and HBV RNA, are increasingly used to refine risk stratification, guide safe treatment discontinuation and identify patients for emerging therapies. Special populations, including pregnant individuals, those undergoing immunosuppression and patients with hepatitis D virus co-infection, require tailored management. Advances in minimally invasive liver fine needle aspiration allow detailed intrahepatic immune and virological profiling, supporting the development of new immunomodulatory and antiviral agents. By combining earlier diagnosis, integrated metabolic assessment, biomarker-led monitoring and novel therapies, the 2025 guidelines provide a blueprint for precision medicine in CHB, with the potential to improve outcomes and reduce the global burden of HBV-related liver disease.
Gill et al. (2025) studied this question.