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《慢性乙型肝炎的管理:加拿大肝脏研究协会和加拿大医学微生物学与传染病协会2025年指南更新》

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.

作者信息

Osiowy Carla, Alvarez Fernando, Coffin Carla S, Cooper Curtis L, Fung Scott K, Ko Hin Hin, Poulin Sébastien, van Gennip Jennifer

机构信息

Viral Hepatitis and Blood-borne Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.

Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.

出版信息

Can Liver J. 2025 May 26;8(2):368-440. doi: 10.3138/canlivj-2025-0012-e. eCollection 2025 May.

Abstract

Chronic hepatitis B virus (HBV) infection poses significant public health challenges in Canada, particularly among newcomers from regions with high HBV prevalence. In alignment with the World Health Organization's goal of HBV elimination by 2030, this 2025 guidelines update-developed jointly by the Canadian Association for the Study of the Liver (CASL) and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada-presents recommendations for universal adult HBV screening, vaccination, laboratory assessment, and treatment. These guidelines emphasize patient-centred care, early diagnosis, and expanded antiviral treatment, including for individuals in the indeterminate or and special populations such as pregnant individuals, children, and those coinfected with HIV, hepatitis C, or hepatitis D. Notably, the guidelines recommend reflex HDV testing and routine use of quantitative HBsAg to support management decisions. These evidence-based recommendations are informed by expert consensus, recent literature, and international standards, with the aim of improving outcomes, reducing stigma, and informing future policy and research priorities.

摘要

慢性乙型肝炎病毒(HBV)感染在加拿大构成了重大的公共卫生挑战,尤其是在来自HBV高流行地区的新移民中。为了与世界卫生组织到2030年消除HBV的目标保持一致,这份2025年指南更新版由加拿大肝脏研究协会(CASL)和加拿大医学微生物学与传染病协会(AMMI)联合制定,提出了针对成人普遍进行HBV筛查、疫苗接种、实验室评估和治疗的建议。这些指南强调以患者为中心的护理、早期诊断以及扩大抗病毒治疗,包括针对处于不确定状态的个体以及孕妇、儿童和同时感染HIV、丙型肝炎或丁型肝炎等特殊人群。值得注意的是,指南建议进行反射性HDV检测并常规使用定量HBsAg以支持管理决策。这些基于证据的建议是由专家共识、近期文献和国际标准得出的,目的是改善治疗效果、减少耻辱感,并为未来的政策和研究重点提供参考。

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本文引用的文献

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