A newly updated clinical practice guideline offers healthcare practitioners vital evidence-based recommendations for managing hepatitis B reactivation (HBVr) in individuals at risk. Hepatitis B reactivation, which can occur due to immune-modulating treatments or underlying diseases, poses significant risks, but antiviral prophylaxis has proven effective in mitigating these risks.
The update, developed through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, follows a systematic review of studies published since the 2014 version of the guideline. It provides clarity on when antiviral treatment should be prescribed and when monitoring alone is appropriate.
Key recommendations include: a strong endorsement of antiviral prophylaxis for individuals at high risk of HBVr; a conditional recommendation for antiviral treatment in those at moderate risk; and a conditional recommendation for clinical monitoring without antiviral therapy for individuals at low risk. Monitoring should occur every 1 to 3 months, incorporating assessments of hepatitis B viral load and alanine aminotransferase levels.
Additionally, the panel stressed the importance of hepatitis B screening for all adults aged 18 and older, aligning with CDC guidelines. The need for tailored screening based on individual HBVr risk is no longer necessary.
This updated guideline is aimed at improving clinical decision-making, ensuring timely interventions for at-risk individuals. It also highlights current evidence gaps and anticipates further updates in five years to maintain its relevance in evolving healthcare contexts.
Helena Bradbury, EMJ
Reference
Ali FS et al. AGA Clinical Practice Guideline on the Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals. Gastroenterology aga. 2025;168(2):267-84.
