Updated Canadian guidelines for management of chronic hepatitis B

Guidelines for the management of chronic hepatitis B have been updated by the Canadian Association for the Study of the Liver (CASL) and AMMI Canada (Association of Medical Microbiology and Infectious Disease Canada). Chronic hepatitis B virus (HBV) infection in Canada is particularly prevalent among newcomers from regions with high HBV prevalence. The estimated number of people living with chronic HBV in Canada is 262,000. Canada has endorsed the World Health Organization’s strategy to eliminate HBV by 2030. In view of this goal, the 2025 guidelines update presents recommendations for universal adult HBV screening, vaccination, laboratory assessment and treatment. The guidelines emphasize patient-centred care, early diagnosis and expanded antiviral treatment, including for individuals in the indeterminate or “grey zone,” as well as for special populations such as pregnant individuals, children and those coinfected with HIV, hepatitis C or hepatitis D. These evidence-based recommendations are informed by expert consensus, recent literature and international standards. They aim to improve outcomes, reduce stigma and inform future policy and research priorities.The 2025 update includes recommendations on the following topics:HBV screening and testing. Universal one-time screening of all adults (>18 years) in Canada is recommended.HDV screening and testingHBV vaccination. Universal infant (ideally at-birth) vaccination is recommended across all Canadian provinces and territories. Universal catch-up (adult) vaccination is recommended for all individuals who have not received a full series of HBV vaccine doses or unsure of their vaccination history.HBV laboratory assessmentHBV treatment, including first-line therapy and endpoints of therapy, as well as an algorithm for hepatitis B treatment initiationHepatocellular carcinoma (HCC) surveillanceManagement of individuals of childbearing age and during pregnancyManagement of HBV and hepatitis D virus (HDV) coinfectionManagement of HBV and hepatitis C virus (HCV) coinfectionManagement of HBV and HIV co-infectionManagement of HBV in pediatric patients.The 2025 guidelines endorse simplified diagnostic pathways and earlier treatment initiation, particularly for individuals who do not clearly meet traditional criteria for treatment (grey zone). Future research priorities include evaluating the cost-effectiveness of screening and vaccination strategies, validating emerging biomarkers, and advancing new antiviral therapies targeting functional or sterilizing cure. To support these efforts, provincial and territorial health systems are encouraged to invest in enhanced HBV surveillance, improved access to recommended HBV/HDV laboratory tests, and the implementation of point-of-care diagnostics, within a patient-centred approach aimed at reducing inequities in access to care and treatment.ReferenceOsiowy C, Alvarez F, Coffin CS, et al; Clinical Practice Guidelines Committee. 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; 8(2). (accessed July 24, 2025).

Updated Canadian guidelines for management of chronic hepatitis B

Register for free access or login.

Related Topics

Business Topic