Intended for healthcare professionals

Practice Guidelines

Diagnosis and management of chronic hepatitis B in children, young people, and adults: summary of NICE guidance

BMJ 2013; 346 doi: (Published 26 June 2013) Cite this as: BMJ 2013;346:f3893
  1. Grammati Sarri, senior research fellow1,
  2. Maggie Westby, clinical effectiveness lead1,
  3. Sarah Bermingham, health economist1,
  4. Grant Hill-Cawthorne, lecturer and clinical adviser2,
  5. Howard Thomas, emeritus professor and chairman of the Guideline Development Group3
  6. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians of London, London NW1 4LE, UK
  2. 2Sydney Emerging Infections and Biosecurity Institute and School of Public Health, University of Sydney, Australia
  3. 3Section of Hepatology and Gastroenterology, Department of Medicine, Imperial College, London
  1. Correspondence to: G Sarri Grammati.sarri{at}

Chronic hepatitis B describes a spectrum of disease resulting from chronic hepatitis B virus (HBV) infection. About a third of the world’s population has serological evidence of past or present HBV infection, and 350-400 million people have chronic HBV infection.1 In the UK about 326 000 people are thought to have chronic hepatitis B.2 In some people, chronic hepatitis B may cause liver fibrosis, cirrhosis, and hepatocellular carcinoma; in others it is inactive and does not lead to important health problems.3 Antiviral therapy suppresses HBV replication and decreases the risk of progressive liver disease.4 This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on the diagnosis and management of chronic hepatitis B in children, young people, and adults.5


NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Assessment and referral in primary care

Children, young people, and adults who are seropositive for HBV surface antigen (HBsAg)

  • Refer to a paediatric or adult hepatologist, gastroenterologist, or infectious disease specialist with an interest in hepatology.

  • Arrange the following tests and include test results with the referral:

    • - Hepatitis B e antigen (HBeAg, an indirect marker of high levels of viraemia and infectivity) or antibody status (anti-HBe, an indirect marker of lower levels of viraemia and infectivity)

    • - HBV DNA level (quantitative direct measure of level of viraemia and infectivity)

    • - IgM antibody to hepatitis B core antigen (IgM anti-HBc, evidence of recent infection with HBV)

    • - Hepatitis C virus antibody (anti-HCV)

    • - Hepatitis delta virus antibody (anti-HDV)

    • - HIV antibody (anti-HIV)

    • - Hepatitis A virus antibody (anti-HAV)

    • - Alanine aminotransferase (ALT) or aspartate aminotransferase, γ-glutamyltransferase, serum albumin, …

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