The Management of Chronic Hepatitis B: 2025 Guidelines Update from the Canadian Association for the Study of the Liver and Association of Medical Microbiology and Infectious Disease Canada

Clinical Practice Guidelines Committee Chair; Carla Osiowy; Panel Members; Fernando Alvarez; Carla S Coffin; Curtis L Cooper; Scott K Fung; Hin Hin Ko; Sébastien Poulin; Jennifer van Gennip

doi:10.3138/canlivj-2025-0012-e

The Management of Chronic Hepatitis B: 2025 Guidelines Update from the Canadian Association for the Study of the Liver and Association of Medical Microbiology and Infectious Disease Canada

Can Liver J. 2025 May 26;8(2):368-440. doi: 10.3138/canlivj-2025-0012-e. eCollection 2025 May.

[Article in English, French]

Authors

Affiliations

¹ Viral Hepatitis and Blood-borne Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
² Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Division of Gastroenterology, Hepatology and Nutrition, CHU Sainte-Justine, University of Montréal, Montréal, Québec, Canada.
⁴ Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁵ Division of Gastroenterology and Hepatology, Immunology, Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁶ Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁷ Department of Medicine , University of Toronto, Ontario, Canada.
⁸ Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
⁹ Centre intégré de santé et de services sociaux des Laurentides, Clinique I.D., Saint-Jérôme, Québec, Canada.
¹⁰ Action Hepatitis Canada, Montréal, QC, Canada.

Abstract

Chronic hepatitis B virus (HBV) infection poses significant public health challenges in Canada, particularly among newcomers from regions with high HBV prevalence. In alignment with the World Health Organization's goal of HBV elimination by 2030, this 2025 guidelines update-developed jointly by the Canadian Association for the Study of the Liver (CASL) and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada-presents recommendations for universal adult HBV screening, vaccination, laboratory assessment, and treatment. These guidelines emphasize patient-centred care, early diagnosis, and expanded antiviral treatment, including for individuals in the indeterminate or grey zone and special populations such as pregnant individuals, children, and those coinfected with HIV, hepatitis C, or hepatitis D. Notably, the guidelines recommend reflex HDV testing and routine use of quantitative HBsAg to support management decisions. These evidence-based recommendations are informed by expert consensus, recent literature, and international standards, with the aim of improving outcomes, reducing stigma, and informing future policy and research priorities.

Keywords: Association of Medical Microbiology and Infectious Disease (AMMI) Canada; Canadian Association for the Study of the Liver (CASL); guidelines; hepatitis B; update.