Introduction

Hepatitis B is an important  public health issue in South Africa (SA). Prior to the introduction of the hepatitis B vaccine into the South African Expanded Programme of Immunisation  (EPI) in 1995, prevalence rates of this disease were 0.3 - 15%.[1] However, unlike countries such as Taiwan,[2] SA has had no catch-up vaccination programme to ensure complete vaccination coverage. In addition, the HIV/AIDS pandemic has had a potentially deleterious influence on the natural history of patients co-infected with HIV and the hepatitis B virus (HBV).[3]

The spectrum of disease and natural history of chronic HBV infection is diverse, ranging from a low viraemic immune control state to progressive chronic hepatitis, with the potential for the ensuing complications of cirrhosis, liver failure and hepatocellular carcinoma (HCC).[4] As understanding of the natural history of chronic hepatitis B increased over the past decade, there have been significant therapeutic advances. The decision to treat and the choice of therapy is dependent on both the phase of chronic infection and patient factors.

This guideline draws on the recently published guidelines by the American Association for the Study of Liver Disease (AASLD), the European Association for the Study of the Liver (EASL), the Asia-Pacific Association for the Study of the Liver (APASL), National Institutes of Health (NIH) and the World Gastroenterology Organisation (WGO).[5-9]  It serves as an attempt to contextualise practice guidelines on the management of chronic hepatitis B in SA.