EASL Clinical Practice Guidelines

Unresolved issues and unmet needs

  1. Improve knowledge and prognosis of the natural history and indications for treatment, particularly in HBeAg-positive immunotolerant patients and HBeAg-negative patients with serum HBV DNA levels below 20,000 IU/ml.
  2. Assess the role of non-invasive markers (serum and biophysical) for the evaluation of the severity of liver disease and for the follow-up of treated and untreated patients.
  3. Further clarify the role of serum HBsAg levels in the evaluation of the natural history, prediction of therapeutic responses and treatment individualisation.
  4. Assess host genetic and viral markers to determine prognosis and optimise patients' management.
  5. Assess the impact of early diagnosis and early treatment intervention.
  6. Assess long-term safety and resistance to the current first-line NAs (entecavir and tenofovir).
  7. Identify markers that predict successful NA discontinuation.
  8. Assess the safety and efficacy of the combination of PEG-IFN with a potent NA (entecavir or tenofovir) to increase anti-HBe and anti-HBs seroconversion rates.
  9. Develop and assess new drugs and therapeutic approaches, particularly immunomodulatory therapies, to enhance loss of HBeAg and HBsAg and subsequent seroconversion.
  10. Assess long-term impact of therapy on the prevention of cirrhosis and its complications and HCC.
  11. Develop strategies and identify subgroups for effective HBIg free prophylaxis after liver transplantation for HBV related liver disease.
  12. Develop effective and optimum treatment for HDV co-infection.