On May 10,2025,the European Association for the Study of the Liver(EASL)released the latest version of Clinical Practice Guidelines on the Management of Chronic Hepatitis B Virus Infection.Based on the latest research advances,the guidelines provide comprehensive recommendations for the diagnosis,treatment,and prevention of HBV infection,covering ten key areas of diagnostic criteria,treatment goals,indications for treatment,therapeutic strategies,hepatocellular carcinoma surveillance,management of special populations,prevention of HBV reactivation,post-transplant care,prevention strategies,and future research priorities.This article summarizes and makes an excerpt of the key recommendations from the updated guidelines.

On May 10,2025,the European Association for the Study of the Liver(EASL)released the latest version of Clinical Practice Guidelines on the Management of Chronic Hepatitis B Virus Infection.Based on the latest research advances,the guidelines provide comprehensive recommendations for the diagnosis,treatment,and prevention of HBV infection,covering ten key areas of diagnostic criteria,treatment goals,indications for treatment,therapeutic strategies,hepatocellular carcinoma surveillance,management of special populations,prevention of HBV reactivation,post-transplant care,prevention strategies,and future research priorities.This article summarizes and makes an excerpt of the key recommendations from the updated guidelines.

Chronic hepatitis B virus(HBV)infection remains a major public health challenge in China,affecting over 70 million people and posing great challenges to the prevention and control of the disease.At present,both the government and sectors of the society are making efforts to achieve the goal of eliminating viral hepatitis as a public health threat by 2030.Mother-to-child transmission is the main route of transmission of HBV,and therefore,blocking the mother-to-child transmission of HBV is the key link in eliminating viral hepatitis.At present,several critical issues still remain unresolved,including the long-term safety of tenofovir alafenamide fumarate during pregnancy,the safety of antiviral therapy in early pregnancy,the effectiveness of immunoglobulin-free strategy,and the risk of HBV transmission through germ cells.Addressing these challenges is important for promoting the blocking of the mother-to-child transmission of HBV and accelerating the progress toward the 2030 goals.

Objective To investigate the value of SpyGlass single-operator choledochoscopy system in the diagnosis and treatment of patients with unexplained biliary stricture, complex bile duct stones, or other biliary tract diseases. Methods A retrospective analysis was performed for the clinical data of the patients with biliary tract diseases who were diagnosed and treated with SpyGlass in The Second Affiliated Hospital of Nanjing Medical University from December 2017 to June 2020. For the patients with biliary stricture, the biliary lesions were fully visualized under the guidance of SpyGlass, and SpyBite biopsy was performed if necessary; the patients with bile duct stones were treated with SpyGlass-guided direct-view laser lithotripsy; for the patients with gallbladder disease, the cystic duct was superselected with the assistance of SpyGlass. The SpyGlass system was analyzed in terms of its sensitivity, specificity, and accuracy rate in diagnosis and treatment, lithotripsy success rate, stone clearance rate, procedure success rate, and incidence rate of complications. Results A total of 58 patients underwent SpyGlass procedure. SpyGlass was used to evaluate biliary stricture of unknown nature in 44 (76%) patients; SpyGlass visual impression had a diagnostic sensitivity of 92% (24/26), a specificity of 94% (17/18), and an accuracy of 93% (41/44), and SpyBite biopsy had a diagnostic sensitivity of 71% (15/21), a specificity of 92% (11/12), and an accuracy of 79% (26/33). SpyGlass was used for the treatment of bile duct stones in 8 patients (14%), with a lithotripsy success rate of 83% (5/6) and a stone clearance rate of 88% (7/8). A guide wire under the SpyGlass system was to superselect the cystic duct in 5 patients (9%), with a procedure success rate of 80% (4/5). In one patient (1%), SpyGlass was used to assist the removal of common bile duct stones after liver transplantation and the treatment of bile duct anastomotic stricture. A total of 5 patients (9%) experienced complications after surgery. Conclusion The SpyGlass choledochoscopy system is accurate, safe, and effective in the diagnosis and treatment of unexplained biliary stricture, complex bile duct stones, and other biliary tract diseases.

The World Health Organization(WHO)has set the goal to eliminate viral hepatitis as a public health threat by 2030, and the key to achieve this ambitious goal lies on the standardized and precise management of pregnant women and their infants by effectively blocking mother-to-child transmission (MTCT) of hepatitis B virus (HBV). Standardized management includes screening and antiviral intervention during pregnancy, infant immunization, and evaluation of immune effect, breastfeeding and mode of delivery. The results of randomized controlled clinical trials and real-world data have confirmed that the comprehensive prevention strategy based on combined immune prophylaxis of neonates can effectively block MTCT of HBV. It is one of the key links to eliminate viral hepatitis in our country, and to formulate a new strategy in line with the public health needs at home and abroad and thereby promote the implementation and application of standardized management process to improve the public's awareness of the disease.

Objective: To investigate the impact of immediate cessation of antiviral therapy on postpartum liver function and the factors influencing postpartum abnormality in mothers with chronic hepatitis B virus infection. Methods: A retrospective cohort study was conducted. One hundred eighty-eight pregnant women with HBV DNA level > 2×106 IU/ml were enrolled from June 2014 to June 2018. Demographic information and clinical data of liver function and HBV DNA load during gravidity, intrapartum and postpartum period were collected. According to the antiviral treatment recommendations during pregnancy, the women were divided into three groups, namely, tenofovir (TDF), telbivudine (LdT) and control group. Liver function abnormalities among the three groups were compared within 6 months after delivery, and the factors influencing abnormal liver function were analyzed by unconditional logistic regression. Results: Of the 188 cases, 72 cases were in the TDF group, 80 cases in the LdT group, and 36 cases in the control group. Pregnant women in the TDF and LdT groups received oral TDF (300 mg/d) and LdT (600 mg/d) from 28 ± 4 weeks of gestation till delivery. Among the 188 patients, 30 (16.0%) had abnormal postpartum liver function abnormality. The incidence of postpartum liver function abnormality [alanine aminotransferase (ALT) > 2 × upper limit of normal (ULN)] in the TDF, LdT, and control groups was 19.4%, 12.5%, and 16.7%, respectively. The postpartum peak levels of ALT (median, range) in the three groups were 34.5 (12.0-946.0) U/L, 37.5 (12.0-733.8) U/L, and 39.0 (7.0-513.0) U/L, respectively. There was no significant difference between the two indexes among the three groups (P > 0.05). There was no statistically significant difference in the degree of postpartum liver function abnormalities between the three groups (P = 0.944). Most of the liver function abnormalities were mild to moderate (2 × ULN≤ALT < 10 × ULN), and usually resolved spontaneously or by treatment. Univariate and multivariate analysis showed that baseline ALT level during pregnancy was an independent factor associated with postpartum liver function abnormality (OR = 1.031, CI 95%: 1.005-1.058; χ² = 5.340, P = 0.021), whereas age, antiviral therapy, HBeAg-positivity, baseline HBV DNA levels, gravidity, parity, preterm delivery and delivery mode were not significantly associated with postpartum liver function abnormality. Conclusion Cessation of antiviral therapy after delivery did not significantly increase the risk of postpartum liver function abnormality in pregnant women with chronic HBV infection. The ALT level during pregnancy is a factor influencing postpartum liver function abnormality.

Hepatitis B virus (HBV) infection is a global public health problem. Hepatitis B core antibody (anti-HBc) is one of the serum immunological markers in human body after HBV infection. Previous studies have shown that the low serum level of anti-HBc in HBeAg-positive mothers are associated with immunoprophylaxis failure in infants. In addition, anti-HBc is an important biomarker associated with liver inflammatory activity and therapeutic outcome and can be used to evaluate liver inflammation and predict the efficacy of antiviral therapy and sustained response after drug withdrawal. Anti-HBc quantification provides a new direction for individualized treatment of hepatitis B patients.

To eliminate viral hepatitis as a public health threat, the World Health Organization has set the ambitious goal of reducing the prevalence of hepatitis B surface antigen (HBsAg) in children to 0.1% by 2030, and the key to this grand goal is cutting off hepatitis B virus (HBV) transmission from mother-to-child. Previously, national and international guidelines for the management of chronic hepatitis B recommended the use of hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) or combination of any in neonates and antiviral drugs for pregnant women with high viral load in late pregnancy. However, a recent study in Thailand found that the addition of antiviral drugs in pregnant women with high viral load in the third trimester did not significantly lower the incidence of mother-to-child HBV transmission, but no case of chronic HBV infection was seen with strict standards hepatitis B vaccine and HBIG combined immunoprophylaxis and the use of tenofovir disoproxil in pregnant women with high viral load in the third trimester. In addition, the incidence of mother –to- child transmission of HBV in the antiviral group was 0, while the incidence of HBV transmission in the placebo group was 2%. Therefore, it is not possible to deny the efficacy of adding antiviral drugs in treating pregnant women with high viral load in the third trimester with combined immunoprophylaxis. There is an urgent need for more real-world studies in clinical practice to further reveal the principles and existing problems of mother- to- child transmission of HBV.

Chronic hepatitis B is a serious public health issue in China. The clinical management of hepatitis B is effective with the emergence of antiviral agents. The outcome of long-term therapy and nucleos(t)ide analogues stopping rules are currently unresolved issues and unmet needs. Thus, we need to pay more attention to clinical research to build large-sample and long-term follow-up cohorts and begin with the end in mind. We believe that the way to resolve the issues above will be found with the efforts of generations.

Chronic hepatitis B virus infection is a great threat to public health around the world.National,Asian-Pacific,or global clinical research collaborative network plays an important role in exploring new therapeutic strategies and biological markers and preventing mother-to-child transmission of hepatitis B.We believe that such network may help to realize a future without hepatitis B.