HBV management: Guidance for PCPs

This updated 2025 guidance offers practical recommendations for the prevention, diagnosis, and management of hepatitis B - aimed specifically for primary care providers and non-specialists. Developed by the HBV Primary Care Workgroup, it builds on the original 2020 guidance with simplified, up-to-date information to support clinical decision-making. 

Click here for the full PDF guidance.

Last year, Canadian Hepatitis B Network members provided clinician input on Gilead’s submission of Hepcludex (bulevirtide) to the Canadian Drug Agency (CDA), and then subsequently submitted a response letter to the initial review. Both letters are posted below.

As of January 2026, the CDA has updated their recommendation (Bulevirtide (Hepcludex)), and below we highlight key elements that were / were not adopted.

Key elements where CanHepB input was reflected in the final recommendation:

1) Platelet threshold removed at initiation: CDA removed the draft platelet count requirement, acknowledging expert feedback that thrombocytopenia is not a reliable proxy for decompensation and that this criterion excluded patients similar to those enrolled in MYR301.

2) ALT normalization no longer required for renewal: The draft requirement for ALT normalization at 48 weeks was relaxed. In the final recommendation, renewal may proceed based on virologic response (undetectable HDV RNA or ≥2 log₁₀ decline), with ALT monitoring left to specialist judgment rather than mandated normalization.

Elements raised by CanHepB that were not fully adopted:

Decompensated disease and HCC: Despite CanHepB’s recommendation to allow continued treatment in selected patients with decompensated liver disease or HCC based on specialist judgment, the final recommendation maintains exclusion of these populations from routine reimbursement, with re-initiation left to clinical discretion in the event of relapse.