Highlights & Basics
- Hepatitis B is the most common liver infection globally, and continues to be a cause of significant morbidity and mortality, despite the availability of an effective vaccine and antiviral therapies.
- People from endemic areas, or injection drug users and those with high-risk sexual behaviors, are at an increased risk for infection.
- Most people are asymptomatic, although some will present with complications such as cirrhosis, hepatocellular carcinoma (HCC), or liver failure. Cirrhosis and HCC are the leading causes of death.
- Serologic markers are essential in making the diagnosis and evaluating disease activity, including differentiating between people with acute and chronic infection and chronic asymptomatic carriers.
- Main goal of treatment is to improve survival and quality of life by preventing disease progression and development of complications. Current treatments do not completely eradicate the virus. The mainstay of management is antiviral therapy, although some patients also require referral to a liver transplant center.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Hepatitis B virus (HBV) lifecycle. cccDNA=covalently closed circular deoxyribonucleic acid; HBcAg=hepatitis B core antigen; HBeAg=hepatitis B e antigen; HBsAg=hepatitis B surface antigen; mRNA=messenger ribonucleic acid; NTCP=sodium taurocholate co-transporting polypeptide; pgRNA=pregenomic ribonucleic acid
Comparison of approved first-line treatments for hepatitis B e antigen (HBeAg)-positive and HBeAg-negative chronic HBV infection
Hepatitis B virus (HBV) reactivation by immunosuppressive therapy groups. anti-HBc=hepatitis B core antibody; HBsAg=hepatitis B surface antigen; TNF=tumor necrosis factor
Citations
Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018 Apr;67(4):1560-99.[Abstract][Full Text]
European Association for the Study of the Liver. EASL clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2025 Aug;83(2):502-83.[Abstract][Full Text]
World Health Organization. Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection. Mar 2024 [internet publication].[Full Text]
1. Mohanty SR, Kupfer SS, Khiani V. Treatment of chronic hepatitis B. Nat Clin Pract Gastroenterol Hepatol. 2006 Aug;3(8):446-58.[Abstract]
2. Chu CJ, Keeffe EB, Han SH, et al. Hepatitis B virus genotypes in the United States: results of a nationwide study. Gastroenterology. 2003 Aug;125(2):444-51.[Abstract]
3. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018 Apr;67(4):1560-99.[Abstract][Full Text]
4. Chu CJ, Lok AS. Clinical significance of hepatitis B virus genotypes. Hepatology. 2002 May;35(5):1274-6.[Abstract][Full Text]
5. Erhardt A, Blondin D, Hauck K, et al. Response to interferon alfa is hepatitis B virus genotype dependent: genotype A is more sensitive to interferon than genotype D. Gut. 2005 Jul;54(7):1009-13.[Abstract][Full Text]
6. Janssen HL, van Zonneveld M, Senturk H, et al. Pegylated interferon alfa-2b alone or in combination with lamivudine for HBeAg-positive chronic hepatitis B: a randomised trial. Lancet. 2005 Jan 8-14;365(9454):123-9.[Abstract]
7. Kao JH, Wu NH, Chen PJ, et al. Hepatitis B genotypes and the response to interferon therapy. J Hepatol. 2000 Dec;33(6):998-1002.[Abstract]
8. Lau GK, Piratvisuth T, Luo KX, et al. Peginterferon alfa-2a, lamivudine, and the combination for HBeAg-positive chronic hepatitis B. N Engl J Med. 2005 Jun 30;352(26):2682-95.[Abstract]
9. Liu Z, Zhang Y, Xu M, et al. Distribution of hepatitis B virus genotypes and subgenotypes: a meta-analysis. Medicine (Baltimore). 2021 Dec 17;100(50):e27941.[Abstract][Full Text]
10. World Health Organization. Hepatitis B: fact sheet. Jul 2025 [internet publication].[Full Text]
11. Alberts CJ, Clifford GM, Georges D, et al. Worldwide prevalence of hepatitis B virus and hepatitis C virus among patients with cirrhosis at country, region, and global levels: a systematic review. Lancet Gastroenterol Hepatol. 2022 Aug;7(8):724-35.[Abstract][Full Text]
12. Cui F, Blach S, Manzengo Mingiedi C, et al. Global reporting of progress towards elimination of hepatitis B and hepatitis C. Lancet Gastroenterol Hepatol. 2023 Apr;8(4):332-42.[Abstract]
13. Alter MJ. Epidemiology of hepatitis B in Europe and worldwide. J Hepatol. 2003;39(suppl 1):S64-9.[Abstract]
14. Trickey A, Bivegete S, Duffell E, et al. Estimating hepatitis B virus prevalence among key population groups for European Union and European Economic Area countries and the United Kingdom: a modelling study. BMC Infect Dis. 2023 Jul 10;23(1):457.[Abstract][Full Text]
15. Centres for Disease Control and Prevention. 2023 Viral hepatitis surveillance report. Apr 2025 [internet publication].[Full Text]
16. Wong RJ, Brosgart CL, Welch S, et al. An updated assessment of chronic hepatitis B prevalence among foreign-born persons living in the United States. Hepatology. 2021 Aug;74(2):607-26.[Abstract][Full Text]
17. UK Health Security Agency. Hepatitis B in England. Nov 2025 [internet publication].[Full Text]
18. GBD 2019 Europe Hepatitis B & C Collaborators. Hepatitis B and C in Europe: an update from the global burden of disease study 2019. Lancet Public Health. 2023 Sep;8(9):e701-16.[Abstract][Full Text]
19. Bivegete S, McNaughton AL, Trickey A, et al. Estimates of hepatitis B virus prevalence among general population and key risk groups in EU/EEA/UK countries: a systematic review. Euro Surveill. 2023 Jul;28(30):2200738.[Abstract][Full Text]
20. Schweitzer A, Horn J, Mikolajczyk RT, et al. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015 Oct 17;386(10003):1546-55.[Abstract]
21. Khetsuriani N, Lesi O, Desai S, et al. Progress toward the elimination of mother-to-child transmission of hepatitis B virus - worldwide, 2016-2021. MMWR Morb Mortal Wkly Rep. 2022 Jul 29;71(30):958-63.[Abstract][Full Text]
22. Indolfi G, Easterbrook P, Dusheiko G, et al. Hepatitis B virus infection in children and adolescents. Lancet Gastroenterol Hepatol. 2019 Jun;4(6):466-76.[Abstract]
23. Wondmeneh TG, Mekonnen AT. Epidemiology of hepatitis B virus infection among pregnant women in Africa: a systematic review and meta-analysis. BMC Infect Dis. 2024 Sep 5;24(1):921.[Abstract]
24. Riches N, Henrion MYR, MacPherson P, et al. Vertical transmission of hepatitis B virus in the WHO African region: a systematic review and meta-analysis. Lancet Glob Health. 2025 Mar;13(3):e447-58.[Abstract][Full Text]
25. UK Health Security Agency. Mother-to-child transmission of hepatitis B eliminated in England. Feb 2023 [internet publication].[Full Text]
26. Ji DZ, Pang XY, Shen DT, et al. Global prevalence of occult hepatitis B: a systematic review and meta-analysis. J Viral Hepat. 2022 May;29(5):317-29.[Abstract]
27. Im YR, Jagdish R, Leith D, et al. Prevalence of occult hepatitis B virus infection in adults: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022 Oct;7(10):932-42.[Abstract][Full Text]
28. Pan Y, Jia Z, Zhang Y, et al. Estimates of the global prevalence of occult hepatitis B virus infection in population under 18 years old: a systematic review and meta-analysis. Hepatol Int. 2025 Jun;19(3):493-506.[Abstract]
29. Wu J, He J, Xu H. Global prevalence of occult HBV infection in children and adolescents: a systematic review and meta-analysis. Ann Hepatol. 2024 Jan-Feb;29(1):101158.[Abstract][Full Text]
30. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2025 Aug;83(2):502-83.[Abstract][Full Text]
31. Lee WM. Hepatitis B virus infection. N Engl J Med. 1997 Dec 11;337(24):1733-45.[Abstract]
32. Ganem D, Prince AM. Hepatitis B virus infection - natural history and clinical consequences. N Engl J Med. 2004 Mar 11;350(11):1118-29.[Abstract]
33. Centers for Disease Control and Prevention. Clinical overview of hepatitis B. Aug 2025 [internet publication].[Full Text]
34. Guidotti LG, Rochford R, Chung J, et al. Viral clearance without destruction of infected cells during acute HBV infection. Science. 1999 Apr 30;284(5415):825-9.[Abstract]
35. Guidotti LG, Ishikawa T, Hobbs MV, et al. Intracellular inactivation of the hepatitis B virus by cytotoxic T lymphocytes. Immunity. 1996 Jan;4(1):25-36.[Abstract]
36. Chisari FV, Ferrari C. Hepatitis B virus immunopathogenesis. Annu Rev Immunol. 1995;13:29-60.[Abstract]
37. Tuttleman JS, Pourcel C, Summers J. Formation of the pool of covalently closed circular viral DNA in hepadnavirus-infected cells. Cell. 1986 Nov 7;47(3):451-60.[Abstract]
38. Seeger C, Mason WS. Hepatitis B virus biology. Microbiol Mol Biol Rev. 2000 Mar;64(1):51-68.[Abstract][Full Text]
39. Seeger C, Ganem D, Varmus HE. Biochemical and genetic evidence for the hepatitis B virus replication strategy. Science. 1986 Apr 25;232(4749):477-84.[Abstract]
40. Newbold JE, Xin H, Tencza M, et al. The covalently closed duplex form of the hepadnavirus genome exists in situ as a heterogeneous population of viral minichromosomes. J Virol. 1995 Jun;69(6):3350-7.[Abstract][Full Text]
41. Zoulim F. New insight on hepatitis B virus persistence from the study of intrahepatic viral cccDNA. J Hepatol. 2005 Mar;42(3):302-8.[Abstract]
42. Yuen MF, Wong DK, Sum SS, et al. Effect of lamivudine therapy on the serum covalently closed-circular (ccc) DNA of chronic hepatitis B infection. Am J Gastroenterol. 2005 May;100(5):1099-103.[Abstract]
43. Wursthorn K, Lutgehetmann M, Dandri M, et al. Peginterferon alpha-2b plus adefovir induce strong cccDNA decline and HBsAg reduction in patients with chronic hepatitis B. Hepatology. 2006 Sep;44(3):675-84.[Abstract]
44. Wong DK, Yuen MF, Ngai VW, et al. One-year entecavir or lamivudine therapy results in reduction of hepatitis B virus intrahepatic covalently closed circular DNA levels. Antivir Ther. 2006;11(7):909-16.[Abstract]
45. Werle-Lapostolle B, Bowden S, Locarnini S, et al. Persistence of cccDNA during the natural history of chronic hepatitis B and decline during adefovir dipivoxil therapy. Gastroenterology. 2004 Jun;126(7):1750-8.[Abstract]
46. Sung JJ, Wong ML, Bowden S, et al. Intrahepatic hepatitis B virus covalently closed circular DNA can be a predictor of sustained response to therapy. Gastroenterology. 2005 Jun;128(7):1890-7.[Abstract]
47. Bourne EJ, Dienstag JL, Lopez VA, et al. Quantitative analysis of HBV cccDNA from clinical specimens: correlation with clinical and virological response during antiviral therapy. J Viral Hepat. 2007 Jan;14(1):55-63.[Abstract]
48. Chu CJ, Lee SD. Hepatitis B virus/hepatitis C virus coinfection: epidemiology, clinical features, viral interactions and treatment. J Gastroenterol Hepatol. 2008 Apr;23(4):512-20.[Abstract][Full Text]
49. Donato F, Boffetta P, Puoti M. A meta-analysis of epidemiological studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma. Int J Cancer. 1998 Jan 30;75(3):347-54.[Abstract][Full Text]
50. Jamma S, Hussain G, Lau DT. Current concepts of HBV/HCV coinfection: coexistence, but not necessarily in harmony. Curr Hepat Rep. 2010;9(4):260-9.[Abstract][Full Text]
51. Bellecave P, Gouttenoire J, Gajer M, et al. Hepatitis B and C virus coinfection: a novel model system reveals the absence of direct viral interference. Hepatology. 2009 Jul;50(1):46-55.[Abstract][Full Text]
52. Ghendon Y. Perinatal transmission of hepatitis B virus in high-incidence countries. J Virol Methods. 1987 Aug;17(1-2):69-79.[Abstract]
53. Schillie S, Walker T, Veselsky S, et al. Outcomes of infants born to women infected with hepatitis B. Pediatrics. 2015 May;135(5):e1141-7.[Abstract]
54. Goldstein ST, Alter MJ, Williams IT, et al. Incidence and risk factors for acute hepatitis B in the United States, 1982-1998: implications for vaccination programs. J Infect Dis. 2002 Mar 15;185(6):713-9.[Abstract]
55. Rashti R, Alavian SM, Moradi Y, et al. Global prevalence of HCV and/or HBV coinfections among people who inject drugs and female sex workers who live with HIV/AIDS: a systematic review and meta-analysis. Arch Virol. 2020 Sep;165(9):1947-58.[Abstract][Full Text]
56. Degenhardt L, Peacock A, Colledge S, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health. 2017 Dec;5(12):e1192-e1207.[Abstract][Full Text]
57. Razavi-Shearer D, Gamkrelidze I, Pan CQ, et al. The impact of immigration on hepatitis B burden in the United States: a modelling study. Lancet Reg Health Am. 2023 Jun;22:100516.[Abstract][Full Text]
58. Bond WW, Favero MS, Petersen NJ, et al. Survival of hepatitis B virus after drying and storage for one week. Lancet. 1981 Mar 7;1(8219):550-1.[Abstract]
59. Davis LG, Weber DJ, Lemon SM. Horizontal transmission of hepatitis B virus. Lancet. 1989 Apr 22;1(8643):889-93.[Abstract]
60. Falla AM, Hofstraat SHI, Duffell E, et al. Hepatitis B/C in the countries of the EU/EEA: a systematic review of the prevalence among at-risk groups. BMC Infect Dis. 2018 Feb 12;18(1):79.[Abstract][Full Text]
61. Wasley A, Miller JT, Finelli L. Surveillance for acute viral hepatitis: United States, 2005. MMWR Surveill Summ. 2007 Mar 16;56(3):1-24.[Abstract]
62. Thio CL. Hepatitis B in the human immunodeficiency virus-infected patient: epidemiology, natural history, and treatment. Semin Liver Dis. 2003 May;23(2):125-36.[Abstract]
63. Dagnaw M, Muche AA, Geremew BM, et al. Prevalence and burden of HBV-HIV co-morbidity: a global systematic review and meta-analysis. Front Public Health. 2025;13:1565621.[Abstract][Full Text]
64. Strader DB. Understudied populations with hepatitis C. Hepatology. 2002 Nov;36(5 suppl 1):S226-36.[Abstract]
65. Chen G, Wang C, Chen J, et al. Hepatitis B reactivation in hepatitis B and C coinfected patients treated with antiviral agents: A systematic review and meta-analysis. Hepatology. 2017 Jul;66(1):13-26.[Abstract][Full Text]
66. Mücke MM, Backus LI, Mücke VT, et al. Hepatitis B virus reactivation during direct-acting antiviral therapy for hepatitis C: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2018 Mar;3(3):172-80.[Abstract]
67. Dodd RY, Notari EP, Stramer SL. Current prevalence and incidence of infectious disease markers and estimated window-period risk in the American Red Cross blood donor population. Transfusion. 2002 Aug;42(8):975-9.[Abstract]
68. Mahoney FJ, Stewart K, Hu H, et al. Progress toward the elimination of hepatitis B virus transmission among health care workers in the United States. Arch Intern Med. 1997 Dec 8-22;157(22):2601-5.[Abstract]
69. Harpaz R, Von Seidlein L, Averhoff FM, et al. Transmission of hepatitis B virus to multiple patients from a surgeon without evidence of inadequate infection control. N Engl J Med. 1996 Feb 29;334(9):549-54.[Abstract]
70. Lettau LA, Smith JD, Williams D, et al. Transmission of hepatitis B with resultant restriction of surgical practice. JAMA. 1986 Feb 21;255(7):934-7.[Abstract]
71. Singh J, Stoitsova S, Zakrzewska K, et al. Healthcare-associated hepatitis B and C transmission to patients in the EU/EEA and UK: a systematic review of reported outbreaks between 2006 and 2021. BMC Public Health. 2022 Dec 3;22(1):2260.[Abstract][Full Text]
72. Cendoroglo Neto M, Draibe SA, Silva AE, et al. Incidence of and risk factors for hepatitis B virus and hepatitis C virus infection among hemodialysis and CAPD patients: evidence for environmental transmission. Nephrol Dial Transplant. 1995;10(2):240-6.[Abstract]
73. Khalesi Z, Razizadeh MH, Javadi M, et al. Global epidemiology of HBV infection among hemodialysis patients: a systematic review and meta-analysis. Microb Pathog. 2023 Jun;179:106080.[Abstract]
74. Malinis M, Boucher HW, AST Infectious Diseases Community of Practice. Screening of donor and candidate prior to solid organ transplantation-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019 Sep;33(9):e13548.[Abstract][Full Text]
75. Bixler D, Annambhotla P, Montgomery MP, et al. Unexpected hepatitis B virus infection after liver transplantation - United States, 2014-2019. MMWR Morb Mortal Wkly Rep. 2021 Jul 9;70(27):961-6.[Abstract][Full Text]
76. World Health Organization. Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection. Mar 2024 [internet publication].[Full Text]
77. Centers for Disease Control and Prevention. Child and adolescent immunization schedule by age: recommendations for ages 18 years or younger - United States, 2025. Oct 2025 [internet publication].[Full Text]
78. American College of Obstetricians and Gynecologists. Clinical practice guideline no. 6: viral hepatitis in pregnancy. Sep 2023 [internet publication].[Full Text]
79. Centers for Disease Control and Prevention. Adult immunization schedule by age: recommendations for ages 19 years or older - United States, 2025. Oct 2025 [internet publication].[Full Text]
80. Liang TJ. Hepatitis B: the virus and disease. Hepatology. 2009 May;49(suppl 5):S13-21.[Abstract][Full Text]
81. Centers for Disease Control and Prevention. Clinical signs and symptoms of hepatitis B. Feb 2024 [internet publication].[Full Text]
82. McMahon BJ, Alward WL, Hall DB, et al. Acute hepatitis B virus infection: relation of age to the clinical expression of disease and subsequent development of the carrier state. J Infect Dis. 1985 Apr;151(4):599-603.[Abstract]
83. Centers for Disease Control and Prevention. Hepatitis B: clinical testing and diagnosis for hepatitis B. Jan 2025 [internet publication].[Full Text]
84. Rajbhandari R, Nguyen VH, Knoble A, et al. Advances in the management of hepatitis B. BMJ. 2025 Jun 3;389:e079579.[Abstract][Full Text]
85. Amini A, Varsaneux O, Kelly H, et al. Diagnostic accuracy of tests to detect hepatitis B surface antigen: a systematic review of the literature and meta-analysis. BMC Infect Dis. 2017 Nov 1;17(suppl 1):698.[Abstract][Full Text]
86. Kim MN, An J, Kim EH, et al. Vibration-controlled transient elastography for significant fibrosis in treatment-naïve chronic hepatitis B patients: a systematic review and meta-analysis. Clin Mol Hepatol. 2024 Sep;30(suppl):S106-16.[Abstract][Full Text]
87. Poynard T, Morra R, Halfon P, et al. Meta-analyses of FibroTest diagnostic value in chronic liver disease. BMC Gastroenterol. 2007;7:40.[Abstract][Full Text]
88. Yin Z, Zou J, Li Q, et al. Diagnostic value of FIB-4 for liver fibrosis in patients with hepatitis B: a meta-analysis of diagnostic test. Oncotarget. 2017 Apr 4;8(14):22944-53.[Abstract][Full Text]
89. Sterling RK, Patel K, Duarte-Rojo A, et al. AASLD Practice Guideline on blood-based non-invasive liver disease assessments of hepatic fibrosis and steatosis. Hepatology. 15 Mar 2024 [Epub ahead of print].[Abstract][Full Text]
90. Sterling RK, Duarte-Rojo A, Patel K, et al. AASLD Practice Guideline on imaging-based non-invasive liver disease assessments of hepatic fibrosis and steatosis. Hepatology. 15 Mar 2024 [Epub ahead of print].[Abstract]
91. West J, Card TR. Reduced mortality rates following elective percutaneous liver biopsies. Gastroenterology. 2010 Oct;139(4):1230-7.[Abstract][Full Text]
92. Yu G, Cheng M, Duan Y, et al. Predictive value of hepatitis B core-related antigen for multiple recurrence outcomes after treatment cessation in chronic hepatitis B: a meta-analysis study. Viruses. 2025 Jun 30;17(7):929.[Abstract][Full Text]
93. Lazarevic I, Miljanovic D, Banko A, et al. Quantitative HBV core antibodies as a prognostic marker for HBeAg seroclearance: a systematic review with meta-analysis. Viruses. 2024 Jul 12;16(7):1121.[Abstract][Full Text]
94. Jiang T, Leng W, Zhong S. Diagnostic role of circulating miRNAs in the grading of chronic hepatitis B-related liver fibrosis: a systematic review and meta-analysis. Lab Med. 2023 Sep 5;54(5):479-88.[Abstract][Full Text]
95. Centers for Disease Control and Prevention. Public Health Service inter-agency guidelines for screening donors of blood, plasma, organs, tissues, and semen for evidence of hepatitis B and hepatitis C. MMWR Recomm Rep. 1991 Apr 19;40(RR-4):1-17.[Abstract]
96. Chou C, Veracruz N, Chitnis AS, et al. Risk of drug-induced liver injury in chronic hepatitis B and tuberculosis co-infection: a systematic review and meta-analysis. J Viral Hepat. 2022 Dec;29(12):1107-14.[Abstract]
97. Wong RJ, Hubbard A, Bagley L, et al. Estimating prevalence of hepatitis B virus coinfection among adults with tuberculosis: a systematic review with meta-analysis. J Clin Gastroenterol. 2022 Aug 1;56(7):601-17.[Abstract]
98. Colli A, Fraquelli M, Casazza G, et al. Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: a systematic review. Am J Gastroenterol. 2006 Mar;101(3):513-23.[Abstract]
99. Liguori A, Zoncapè M, Casazza G, et al. Staging liver fibrosis and cirrhosis using non-invasive tests in people with chronic hepatitis B to inform WHO 2024 guidelines: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2025 Apr;10(4):332-49.[Abstract][Full Text]
100. Gupta S, Bent S, Kohlwes J. Test characteristics of alpha-fetoprotein for detecting hepatocellular carcinoma in patients with hepatitis C. A systematic review and critical analysis. Ann Intern Med. 2003 Jul 1;139(1):46-50.[Abstract]
101. Soresi M, Magliarisi C, Campagna P, et al. Usefulness of alpha-fetoprotein in the diagnosis of hepatocellular carcinoma. Anticancer Res. 2003 Mar-Apr;23(2C):1747-53.[Abstract]
102. World Health Organization. Global hepatitis report 2017. 2017 [internet publication].[Full Text]
103. Centers for Disease Control and Prevention. Hepatitis B, acute and chronic 2024 Case Definition. Feb 2024 [internet publication].[Full Text]
104. Conners EE, Panagiotakopoulos L, Hofmeister MG, et al. Screening and testing for hepatitis B virus infection: CDC recommendations - United States, 2023. MMWR Recomm Rep. 2023 Mar 10;72(1):1-25.[Abstract][Full Text]
105. US Preventive Services Task Force. Final recommendation statement. Hepatitis B virus infection in adolescents and adults: screening. Dec 2020 [internet publication].[Full Text]
106. Hwang JP, Feld JJ, Hammond SP, et al. Hepatitis B virus screening and management for patients with cancer prior to therapy: ASCO provisional clinical opinion update. J Clin Oncol. 2020 Nov 1;38(31):3698-715.[Abstract][Full Text]
107. Centers for Disease Control and Prevention. Clinical guidance for perinatal hepatitis B testing. 2025 [internet publication].[Full Text]
108. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines: hepatitis B virus (HBV) infection. Jul 2021 [internet publication].[Full Text]
109. International Union against Sexually Transmitted Infections. 2017 European Guideline for the screening, prevention and initial management of hepatitis B & C infections in sexual health settings. 2017 [internet publication].[Full Text]
110. Centers for Disease Control and Prevention. Clinical care of hepatitis B. Jan 2025 [internet publication].[Full Text]
111. Mantzoukis K, Rodríguez-Perálvarez M, Buzzetti E, et al. Pharmacological interventions for acute hepatitis B infection. Cochrane Database Syst Rev. 2017 Mar 21;(3):CD011645.[Abstract][Full Text]
112. Henriquez-Camacho C, Hijas-Gomez AI, Risco Risco C, et al. Lamivudine and entecavir for acute hepatitis B: a systematic review and meta-analysis. Viruses. 2023 Nov 10;15(11):2241.[Abstract][Full Text]
113. Papatheodoridis GV, Lampertico P, Manolakopoulos S, et al. Incidence of hepatocellular carcinoma in chronic hepatitis B patients receiving nucleos(t)ide therapy: a systematic review. J Hepatol. 2010 Aug;53(2):348-56.[Abstract]
114. Sung JJ, Tsoi KK, Wong VW, et al. Meta-analysis: treatment of hepatitis B infection reduces risk of hepatocellular carcinoma. Aliment Pharmacol Ther. 2008 Nov 1;28(9):1067-77.[Abstract]
115. Yim HJ, Kim JH, Park JY, et al. Comparison of clinical practice guidelines for the management of chronic hepatitis B: when to start, when to change, and when to stop. Clin Mol Hepatol. 2020 Oct;26(4):411-29.[Abstract][Full Text]
116. Bourlière M, Rabiega P, Ganne-Carrie N, et al. Effect on HBs antigen clearance of addition of pegylated interferon alfa-2a to nucleos(t)ide analogue therapy versus nucleos(t)ide analogue therapy alone in patients with HBe antigen-negative chronic hepatitis B and sustained undetectable plasma hepatitis B virus DNA: a randomised, controlled, open-label trial. Lancet Gastroenterol Hepatol. 2017 Mar;2(3):177-88.[Abstract]
117. Lumley SF, Delphin M, Mokaya JF, et al. A systematic review and meta-analysis of the risk of hepatitis B virus (HBV) resistance in people treated with entecavir or tenofovir. J Clin Virol. 2024 Oct;174:105711.[Abstract][Full Text]
118. Chen L, Jiang Q, Xu X. Comparison of the effects of tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) on liver function in patients with hepatitis B: a meta-analysis. Altern Ther Health Med. 2025 Jan;31(1):124-7.[Abstract][Full Text]
119. Lampertico P, Buti M, Fung S, et al. Switching from tenofovir disoproxil fumarate to tenofovir alafenamide in virologically suppressed patients with chronic hepatitis B: a randomised, double-blind, phase 3, multicentre non-inferiority study. Lancet Gastroenterol Hepatol. 2020 May;5(5):441-53.[Abstract]
120. Lim YS, Seto WK, Kurosaki M, et al. Review article: switching patients with chronic hepatitis B to tenofovir alafenamide-a review of current data. Aliment Pharmacol Ther. 2022 Apr;55(8):921-43.[Abstract][Full Text]
121. Chan HLY, Buti M, Lim YS, et al. Long-term treatment with tenofovir alafenamide for chronic hepatitis B results in high rates of viral suppression and favorable renal and bone safety. Am J Gastroenterol. 2023 Aug 10.[Abstract][Full Text]
122. Lee J, Lee A, Sung PS, et al. Efficacy comparison of high-genetic barrier nucleos(t)ide analogues in treatment-naïve chronic hepatitis B patients: a network meta-analysis. Korean J Intern Med. 2024 Jul;39(4):577-89.[Abstract][Full Text]
123. Liu SJ, Zhang X, Yan LJ, et al. Comparison of tenofovir versus entecavir for preventing hepatocellular carcinoma in chronic hepatitis B patients: an umbrella review and meta-analysis. J Cancer Res Clin Oncol. 2025 Feb 11;151(2):77.[Abstract][Full Text]
124. Giri S, Agrawal D, Afzalpurkar S, et al. Tenofovir versus entecavir for tertiary prevention of hepatocellular carcinoma in chronic hepatitis B infection after curative therapy: a systematic review and meta-analysis. J Viral Hepat. 2023 Feb;30(2):108-15.[Abstract]
125. Liu H, Han CL, Tian BW, et al. Tenofovir versus entecavir on the prognosis of hepatitis B virus-related hepatocellular carcinoma: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol. 2023 Jan-Jun;17(6):623-33.[Abstract]
126. Luo JX, Chen G, Hu XY, et al. Tenofovir alafenamide versus entecavir in treating patients with chronic hepatitis B: a meta-analysis. [in spa]. Gastroenterol Hepatol. 2025 Apr;48(4):502276.[Abstract]
127. Wu J, Xie S, Ma Y, et al. Entecavir for children and adults with chronic hepatitis B. Cochrane Database Syst Rev. 2025 Apr 22;4(4):CD015536.[Abstract][Full Text]
128. Hsu PY, Su HC, Ma MC, et al. Impact of tenofovir alafenamide on lipid profiles in chronic hepatitis B patients: systematic review and meta-analysis. J Med Virol. 2025 Apr;97(4):e70331.[Abstract]
129. Hwang EG, Jung EA, Yoo JJ, et al. Risk of dyslipidemia in chronic hepatitis B patients taking tenofovir alafenamide: a systematic review and meta-analysis. Hepatol Int. 2023 Aug;17(4):860-9.[Abstract]
130. Lange CM, Bojunga J, Hofmann WP, et al. Severe lactic acidosis during treatment of chronic hepatitis B with entecavir in patients with impaired liver function. Hepatology. 2009 Dec;50(6):2001-6.[Abstract][Full Text]
131. Jiang S, Guo S, Huang Y, et al. Predictors of HBsAg seroclearance in patients with chronic HBV infection treated with pegylated interferon-alpha: a systematic review and meta-analysis. Hepatol Int. 2024 Jun;18(3):892-903.[Abstract][Full Text]
132. Lee SK, Kwon JH, Lee SW, et al. Sustained off therapy response after peglyated interferon favours functional cure and no disease progression in chronic hepatitis B. Liver Int. 2021 Feb;41(2):288-94.[Abstract]
133. Zhang Y, Lin X, Wu H, et al. Systematic review with network meta-analysis: sustained hepatitis B surface antigen clearance after pegylated interferon cessation. Eur J Gastroenterol Hepatol. 2024 Oct 1;36(10):1159-70.[Abstract]
134. Maung ST, Chaiteerakij R. Scoping review on strategies for safe nucleot(s)ide analogue discontinuation and optimising functional cure in chronic hepatitis B. J Viral Hepat. 2025 Jul;32(7):e70040.[Abstract]
135. Buster EH, Hansen BE, Buti M, et al; HBV 99-01 Study Group. Peginterferon alpha-2b is safe and effective in HBeAg-positive chronic hepatitis B patients with advanced fibrosis. Hepatology. 2007 Aug;46(2):388-94.[Abstract][Full Text]
136. Yao Y, Zhang J, Li X, et al. Systematic review: clinical outcomes of discontinuation of oral antivirals in hepatitis B-related liver cirrhosis. Front Public Health. 2022;10:1037527.[Abstract][Full Text]
137. Wang N, He S, Zheng Y, et al. Efficacy and safety of tenofovir disoproxil fumarate versus entecavir in the treatment of acute-on-chronic liver failure with hepatitis B: a systematic review and meta-analysis. BMC Gastroenterol. 2023 Nov 13;23(1):388.[Abstract][Full Text]
138. Perrillo R, Tamburro C, Regenstein F, et al. Low-dose, titratable interferon alfa in decompensated liver disease caused by chronic infection with hepatitis B virus. Gastroenterology. 1995 Sep;109(3):908-16.[Abstract]
139. Sheng LP, Zhang JC, Zhong ZQ, et al. High-potency nucleos(t)ide analogues alone or plus immunoglobulin for HBV prophylaxis after liver transplantation: a meta-analysis. Hepatol Int. 2023 Oct;17(5):1113-24.[Abstract]
140. Altfeld M, Rockstroh JK, Addo M, et al. Reactivation of hepatitis B in a long-term anti-HBs-positive patient with AIDS following lamivudine withdrawal. J Hepatol. 1998 Aug;29(2):306-9.[Abstract]
141. National Institutes of Health, Centers for Disease Control and Prevention, and HIV Medicine Association of the Infectious Disease Society of America Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: hepatitis B virus infection. Dec 2024 [internet publication].[Full Text]
142. Jiang XW, Ye JZ, Li YT, et al. Hepatitis B reactivation in patients receiving direct-acting antiviral therapy or interferon-based therapy for hepatitis C: A systematic review and meta-analysis. World J Gastroenterol. 2018 Jul 28;24(28):3181-91.[Abstract][Full Text]
143. Yurdaydın C, Idilman R, Bozkaya H, et al. Natural history and treatment of chronic delta hepatitis. J Viral Hepat. 2010 Nov;17(11):749-56.[Abstract]
144. Afraie M, Moradi G, Zamani K, et al. The effect of hepatitis B virus on the risk of pregnancy outcomes: a systematic review and meta-analysis of cohort studies. Virol J. 2023 Sep 14;20(1):213.[Abstract][Full Text]
145. Funk AL, Lu Y, Yoshida K, et al. Efficacy and safety of antiviral prophylaxis during pregnancy to prevent mother-to-child transmission of hepatitis B virus: a systematic review and meta-analysis. Lancet Infect Dis. 2021 Jan;21(1):70-84.[Abstract][Full Text]
146. Huang J, Cheng C, Li K, et al. Effectiveness and safety of tenofovir alafenamide fumarate in the prevention of perinatal hepatitis B transmission: a meta-analysis. Dig Dis Sci. 2024 Mar;69(3):978-88.[Abstract]
147. Ugwu EO, Eleje GU, Ugwu AO, et al. Antivirals for prevention of hepatitis B virus mother-to-child transmission in human immunodeficiency virus positive pregnant women co-infected with hepatitis B virus. Cochrane Database Syst Rev. 2023 Jun 12;6(6):CD013653.[Abstract][Full Text]
148. Hyun MH, Lee YS, Kim JH, et al. Systematic review with meta-analysis: the efficacy and safety of tenofovir to prevent mother-to-child transmission of hepatitis B virus. Aliment Pharmacol Ther. 2017 Jun;45(12):1493-505.[Abstract]
149. Li W, Jia L, Zhao X, et al. Efficacy and safety of tenofovir in preventing mother-to-infant transmission of hepatitis B virus: a meta-analysis based on 6 studies from China and 3 studies from other countries. BMC Gastroenterol. 2018 Aug 2;18(1):121.[Abstract][Full Text]
150. Tavakolpour S, Darvishi M, Mirsafaei HS, et al. Nucleoside/nucleotide analogues in the treatment of chronic hepatitis B infection during pregnancy: a systematic review. Infect Dis (Lond). 2017 Oct 11;50(2):95-106.[Abstract]
151. Pan CQ, Zhu L, Yu AS, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for preventing vertical transmission in chronic hepatitis B mothers: a systematic review and meta-analysis. Clin Infect Dis. 2024 Oct 15;79(4):953-64.[Abstract][Full Text]
152. Shi Z, Yang Y, Ma L, et al. Lamivudine in late pregnancy to interrupt in utero transmission of hepatitis B virus: systematic review and meta-analysis. Obstet Gynecol. 2010 Jul;116(1):147-59.[Abstract]
153. Su GG, Pan KH, Zhao NF, et al. Efficacy and safety of lamivudine treatment for chronic hepatitis B in pregnancy. World J Gastroenterol. 2004 Mar 15;10(6):910-2.[Abstract]
154. van Zonneveld M, van Nunen AB, Niesters HG, et al. Lamivudine treatment during pregnancy to prevent perinatal transmission of hepatitis B virus infection. J Viral Hepat. 2003 Jul;10(4):294-7.[Abstract]
155. Xu WM, Cui YT, Wang L, et al. Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat. 2009 Feb;16(2):94-103.[Abstract]
156. He R, Wen P, Xiong M, et al. Cesarean section in reducing mother-to-child HBV transmission: a meta-analysis. J Matern Fetal Neonatal Med. 2022 Sep;35(18):3424-32.[Abstract]
157. European Association for the Study of the Liver. EASL Clinical practice guidelines on the management of liver diseases in pregnancy. J Hepatol. 2023 Sep;79(3):768-828.[Abstract][Full Text]
158. Pak K, Ibrahim B, Saab S. Safety of tenofovir disoproxil fumarate among breastfeeding infants of patients with chronic hepatitis B: a systematic review. J Viral Hepat. 2024 Nov;31(11):760-7.[Abstract]
159. Li M, Li Q, Qu J, et al. The effectiveness of combination therapy with interferon and nucleoside analogs in pediatric patients with chronic hepatitis B: a systematic review and meta-analysis. Hepatol Int. 2023 Feb;17(1):52-62.[Abstract]
160. Shi Z, Yang Y, Wang H, et al. Breastfeeding of newborns by mothers carrying hepatitis B virus: a meta-analysis and systematic review. Arch Pediatr Adolesc Med. 2011 Sep;165(9):837-46.[Abstract]
161. Pak K, Ibrahim B, Saab S. Safety of Tenofovir Disoproxil Fumarate Among Breastfeeding Infants of Patients With Chronic Hepatitis B: A Systematic Review. J Viral Hepat. 2024 Nov;31(11):760-767.[Abstract][Full Text]
162. Papatheodoridi M, Papatheodoridis GV. State-of-the-art and emerging antivirals for chronic hepatitis B infection. Expert Opin Pharmacother. 2022 Dec;23(18):1999-2012.[Abstract]
163. Geta M, Mengistu G, Yizengaw E, et al. Efficacy and safety of therapeutic vaccines for the treatment of chronic hepatitis B: a systematic review and meta-analysis of randomized controlled trials update. Medicine (Baltimore). 2024 Aug 30;103(35):e39344.[Abstract][Full Text]
164. Bloom K, Maepa MB, Ely A, et al. Gene therapy for chronic HBV-can we eliminate cccDNA? Genes (Basel). 2018 Apr 12;9(4).[Abstract][Full Text]
165. Hepatitis B Foundation. Treatment options: drug watch. Sep 2025 [internet publication].[Full Text]
166. Chen J, Ji D, Jia J, et al. Functional cure with new antiviral therapy for hepatitis B virus: a systematic review and meta-analysis. Hepatol Int. 2025 Aug;19(4):773-95.[Abstract]
167. Wang Y, Xiong J, Niu M, et al. Statins and the risk of cirrhosis in hepatitis B or C patients: a systematic review and dose-response meta-analysis of observational studies. Oncotarget. 2017 Jul 27;8(35):59666-76.[Abstract][Full Text]
168. Simon TG, Duberg AS, Aleman S, et al. Lipophilic statins and risk for hepatocellular carcinoma and death in patients with chronic viral hepatitis: results from a nationwide Swedish population. Ann Intern Med. 2019 Sep 3;171(5):318-27.[Abstract][Full Text]
169. Vahedian-Azimi A, Shojaie S, Banach M, et al. Statin therapy in chronic viral hepatitis: a systematic review and meta-analysis of nine studies with 195,602 participants. Ann Med. 2021 Dec;53(1):1227-42.[Abstract][Full Text]
170. Li Z, Li Y, Li X, et al. Statins in Hepatitis B or C patients is associated with reduced hepatocellular carcinoma risk: a systematic review and meta-analysis. Turk J Gastroenterol. 2022 Feb;33(2):136-44.[Abstract][Full Text]
171. Kumar SE, Sithamparapillai K, Choudhury AK, et al. Therapeutic plasma exchange in patients with acute-on-chronic liver failure improves survival-an updated meta-analysis. Liver Int. 2025 May;45(5):e70018.[Abstract]
172. Zhang L, Ma Y, Wang X, et al. Comparative efficacy of double plasma molecular adsorption system combined with plasma exchange versus plasma exchange in treating acute-on-chronic liver failure due to hepatitis B: a meta-analysis. J Clin Apher. 2024 Aug;39(4):e22140.[Abstract][Full Text]
173. Society for Maternal-Fetal Medicine. Hepatitis B in pregnancy: updated guidelines. 2024 [internet publication].[Full Text]
174. Coffin C, Fung S, Alvarez MD; Canadian Association for the Study of Liver Disease. Management of hepatitis B virus infection: 2018 guidelines from the Canadian Association for the Study of Liver Disease and Association of Medical Microbiology and Infectious Disease Canada. Dec 2018 [internet publication].[Full Text]
175. Feld J, Janssen HL, Abbas Z, et al. World Gastroenterology Organisation global guideline hepatitis B: September 2015. J Clin Gastroenterol. 2016 Oct;50(9):691-703.[Abstract]
176. Niederau C, Heintges T, Lange S, et al. Long-term follow-up of HBeAg-positive patients treated with interferon alfa for chronic hepatitis B. N Engl J Med. 1996 May 30;334(22):1422-7.[Abstract]
177. Gish RG, Chang TT, Lai CL, et al. Loss of HBsAg antigen during treatment with entecavir or lamivudine in nucleoside-naive HBeAg-positive patients with chronic hepatitis B. J Viral Hepat. 2010 Jan;17(1):16-22.[Abstract]
178. Yim HJ, Lok AS. Natural history of chronic hepatitis B virus infection: what we knew in 1981 and what we know in 2005. Hepatology. 2006 Feb;43(2 suppl 1):S173-81.[Abstract]
179. El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012 May;142(6):1264-73.e1.[Abstract][Full Text]
180. Chang TE, Su CW, Huang YS, et al. Hepatitis D virus dual infection increased the risk of hepatocellular carcinoma compared with hepatitis B virus mono infection: a meta-analysis. J Chin Med Assoc. 2022 Jan 1;85(1):30-41.[Abstract][Full Text]
181. Bosch FX, Ribes J, Cleries R, et al. Epidemiology of hepatocellular carcinoma. Clin Liver Dis. 2005 May;9(2):191-211, v.[Abstract]
182. Yang HI, Lu SN, Liaw YF, et al. Hepatitis B e antigen and the risk of hepatocellular carcinoma. N Engl J Med. 2002 Jul 18;347(3):168-74.[Abstract]
183. Iloeje UH, Yang HI, Su J, et al. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology. 2006 Mar;130(3):678-86.[Abstract]
184. Kuang XJ, Jia RR, Huo RR, et al. Systematic review of risk factors of hepatocellular carcinoma after hepatitis B surface antigen seroclearance. J Viral Hepat. 2018 May 2;25(9):1026-37.[Abstract]
185. Tsuboi R, Sanada T, Takamori K, et al. Isolation and properties of extracellular proteinases from Sporothrix schenckii. J Bacteriol. 1987 Sep;169(9):4104-9.[Abstract][Full Text]
186. Kamal H, Fornes R, Simin J, et al. Risk of hepatocellular carcinoma in hepatitis B and D virus co-infected patients: a systematic review and meta-analysis of longitudinal studies. J Viral Hepat. 2021 Oct;28(10):1431-42.[Abstract][Full Text]
187. Loomba R, Liang TJ. Hepatitis B reactivation associated with immune suppressive and biological modifier therapies: current concepts, management strategies, and future directions. Gastroenterology. 2017 May;152(6):1297-309.[Abstract][Full Text]
188. Shi Y, Zheng M. Hepatitis B virus persistence and reactivation. BMJ. 2020 Sep 1;370:m2200.[Abstract][Full Text]
189. Papatheodoridi M, Tampaki M, Lok AS, et al. Risk of HBV reactivation during therapies for HCC: a systematic review. Hepatology. 2022 May;75(5):1257-74.[Abstract]
190. American Gastroenterological Association. Guideline on prevention and treatment of hepatitis B reactivation. Jan 2025 [internet pubication].[Full Text]
191. Kamiza AB, Fatumo S, Singini MG, et al. Hepatitis B infection is causally associated with extrahepatic cancers: a Mendelian randomization study. EBioMedicine. 2022 May;79:104003.[Abstract][Full Text]
192. Lee DH, Chung SW, Lee JH, et al. Association of chronic hepatitis B infection and antiviral treatment with the development of the extrahepatic malignancies: a nationwide cohort study. J Clin Oncol. 2022 Oct 10;40(29):3394-405.[Abstract]
193. Zhang L, Zhang F, Ma Z, et al. Hepatitis B virus infection, infertility, and assisted reproduction. [in chi]. J Zhejiang Univ Sci B. 2024 Aug 15;25(8):672-85.[Abstract]
194. Xu Y, Gan K, Hou L, et al. The association between hepatitis B virus and semen quality: a systematic review and meta-analysis. BMC Urol. 2024 Feb 22;24(1):47.[Abstract]
195. Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology. 2007 Feb;45(2):507-39.[Abstract][Full Text]
196. Buti M, Wong DK, Gane E, et al. Safety and efficacy of stopping tenofovir disoproxil fumarate in patients with chronic hepatitis B following at least 8 years of therapy: a prespecified follow-up analysis of two randomised trials. Lancet Gastroenterol Hepatol. 2019 Apr;4(4):296-304.[Abstract]
197. World Health Organization. New good practice statement on counselling behavioural interventions for key populations to prevent HIV, viral hepatitis and STIs. Jun 2023 [internet publication].[Full Text]
