ALEH position statement on the management of hepatitis B virus infection 2025

Abstract

Chronic hepatitis B virus (HBV) infection remains a major cause of cirrhosis and hepatocellular carcinoma worldwide, with substantial public health implications in Latin America. Despite the availability of an effective vaccine, HBV continues to be underdiagnosed and undertreated across the region, where healthcare access is often limited and heterogeneous. In alignment with the World Health Organization’s 2024 strategy for HBV elimination, the Latin American Association for the Study of the Liver (ALEH) presents updated regional guidelines to simplify diagnosis, expand treatment eligibility, and improve vaccination coverage. The recommendations emphasize the use of rapid diagnostic tests and reflex HBV DNA testing to overcome barriers to laboratory access, while promoting non-invasive methods to assess liver disease severity. Expanded treatment criteria include patients with significant fibrosis, elevated HBV DNA levels, co-infections, and other risk factors, ensuring broader access to antiviral therapy with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), or entecavir (ETV). Preventing mother-to-child transmission through universal screening, maternal prophylaxis, and timely neonatal vaccination is prioritized. Additionally, universal HDV testing in HBV-infected patients is recommended. These guidelines highlight the urgent need for decentralization, simplification, and equity in HBV management to achieve elimination goals in Latin America by 2030.