Real-world evidence supports earlier treatment in HBeAg-positive but not HBeAg-negative chronic hepatitis B virus infection

In chronic hepatitis B virus (HBV) infection, the central debate remains whom and when to treat. The 2025 European Association for the Study of the Liver (EASL) Clinical Practice Guidelines (CPGs)1 have expanded treatment eligibility but still do not suggest treatment for all HBV DNA-positive individuals. Instead, they reflect a nuanced, risk-based balance: reassuring that individuals with HBeAg-negative infection (formerly termed ‘inactive carriers’) generally have an excellent prognosis without treatment, while advocating earlier intervention in selected HBeAg-positive individuals, particularly when risk factors for hepatocellular carcinoma (HCC) are present. The guidelines distinguish between individuals who should or can be treated based on levels of evidence and outline situations where treatment may be deferred.1