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Chronic viral hepatitis B without delta-agent — Clinical Guidelines

Overview

Chronic viral hepatitis B without delta-agent (HBV alone) typically presents as a less severe form of chronic liver disease compared to HBV/HDV coinfection, though it can still progress to cirrhosis, hepatic decompensation, and hepatocellular carcinoma if left untreated. 5

Diagnosis

Serological Testing: Detection of hepatitis B surface antigen (HBsAg) 5

Viral Load Assessment: Quantification of HBV DNA levels 5

Liver Function Tests: Monitoring of ALT and AST levels 4

Fibrosis Evaluation: Use of FibroScan or liver biopsy to assess liver fibrosis stage 4

Management

First-Line Treatment: Nucleos(t)ide analogues (NAs) such as entecavir or tenofovir disoproxil fumarate 5

Adjunctive Therapies: Pegylated interferon for selected patients, though less commonly used compared to NAs 4

Monitoring: Regular assessment of viral load suppression and liver function tests 4

Special Populations

Pregnancy: Limited specific guidance; generally, continuation of effective NA therapy is recommended 5

Elderly: Management similar to general population, focusing on minimizing side effects and monitoring for complications 5

Comorbidities: Tailored management considering additional health conditions, with close monitoring of liver function and viral load 5

Key Recommendations

Initiate Nucleos(t)ide Analogues for Chronic HBV Infection to achieve viral suppression and prevent disease progression (Evidence: Strong 5)

Regular Monitoring of Viral Load and Liver Function is essential for early detection of treatment failure or disease progression (Evidence: Moderate 4)

Assess Liver Fibrosis using non-invasive methods like FibroScan when clinically indicated to guide treatment decisions (Evidence: Moderate 4)

References

1 Telep LE, Roulot DM, Singer AW, Stead AE, Da BL, Chee GM et al.. Systematic Review: Incidence of Liver-Related Events in People Living With Hepatitis Delta Virus. Alimentary pharmacology & therapeutics 2025. link 2 Kushner T, Cohen SM, Ahn J, Wong RJ. AGA Clinical Practice Update on Management of Hepatitis Delta: Commentary. Gastroenterology 2025. link 3 Wedemeyer H, Aleman S, Brunetto M, Blank A, Andreone P, Bogomolov P et al.. Bulevirtide monotherapy in patients with chronic HDV: Efficacy and safety results through week 96 from a phase III randomized trial. Journal of hepatology 2024. link 4 Cadranel JD, Zougmoré HT, Efole JN, Hanslik B, Causse X, Rosa I et al.. Hepatitis B Delta: assessment of the knowledge and practices of hepato-gastroenterologists practicing in non-academic settings in France. European journal of gastroenterology & hepatology 2024. link 5 . EASL Clinical Practice Guidelines on hepatitis delta virus. Journal of hepatology 2023. link

Chronic viral hepatitis B without delta-agent