Vnitr Lek 2025, 71(7):E13-E29 | DOI: 10.36290/vnl.2025.086

Diagnosis and therapy of hepatitis B virus infection: Czech national guidelines

Petr Husa1, Jan Šperl, Petr Urbánek3, Soňa Fraňková2
1 Klinika infekčních chorob Lékařské fakulty MU a FN Brno
2 Klinika hepatogastroenterologie IKEM, Praha
3 Interní klinika 1. lékařské fakulty UK a ÚVN, Praha

The new recommendations reflect the increase in knowledge that has been reported since the release of previous Czech guidelines in September 2017. The base for these guidelines were European Association for the Study of the Liver (EASL) guidelines from May 2025. According to qualified estimates, there are 254 million people with chronic hepatitis B (HBV) infection worldwide. The Czech Republic is among the countries with a low prevalence of HBV infection. HBV infection can cause serious, life-threatening liver damage - fulminant hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). The main goal of treatment is to prolong life and improve its quality by preventing the progression of chronic hepatitis to liver cirrhosis, decompensation of cirrhosis, and the development of HCC. A prerequisite for achieving this goal is sustained suppression of HBV replication. Other treatment goals include preventing vertical transmission of infection from mother to newborn, preventing HBV reactivation, treating extrahepatic manifestations (EHM) of HBV, and reducing the likelihood of HBV transmission between individuals. In general, there are two possible strategies for treating chronic hepatitis B: treatment with nucleos(t)ide analogues (NAs) or pegylated interferon alfa. Currently, the vast majority of patients in the Czech Republic and throughout Europe are treated with NAs. Entecavir (ETV), tenofovir disoproxil fumarate (TDF), or tenofovir alafenamide (TAF) should be used as first-line NAs. The main advantage of treatment with highly effective NAs with a high genetic barrier to resistance is predictably high and long-term antiviral efficacy leading to undetectable HBV DNA in serum in the vast majority of adherent patients and the favorable safety profile of these drugs. These NAs can be used to treat any patient with chronic hepatitis B and are the only treatment option for patients with decompensated liver cirrhosis, after liver transplantation, with EHM HBV infection, severe acute hepatitis B, or exacerbation of chronic hepatitis B. When deciding between ETV, TDF, and TAF, it is necessary to assess comorbidities (especially renal insufficiency and bone density reduction) and other factors (women of childbearing age, pregnant women, older age).

Keywords: chronic hepatitis B, entecavir (ETV), tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF).

Accepted: October 16, 2025; Published: October 31, 2025  Show citation

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Husa P, Šperl J, Urbánek P, Fraňková S. Diagnosis and therapy of hepatitis B virus infection: Czech national guidelines. Vnitr Lek. 2025;71(7):E13-29. doi: 10.36290/vnl.2025.086.
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