The APASL 2026 chronic hepatitis B guideline was updated against the backdrop of a substantial disease burden in the Asia-Pacific region, where a large proportion of people living with chronic hepatitis B still remain undiagnosed or untreated. The revision also responds to the need to align clinical practice with the WHO 2030 goal of eliminating viral hepatitis as a public health threat, while incorporating newer evidence on non-invasive liver assessment, quantitative HBsAg, and first-line antiviral strategies.

The key updates can be summarized as follows:

l  Treatment initiation has been further broadened, with HBV DNA detectability and elevated ALT prompting consideration of therapy, while higher-risk groups such as patients with cirrhosis, a family history of hepatocellular carcinoma, and those with metabolic comorbidities may warrant treatment without delay.

l  Routine screening for MAFLD, obesity, and diabetes is emphasized, with greater attention to their interaction with HBV, and individualized management is refined for pregnant women, patients with HIV or HDV coinfection, and those receiving immunosuppressive therapy.

l  Blood-based scores such as APRI and FIB-4, together with liver elastography, are reinforced as first-line tools for fibrosis assessment. In the guideline summary, vibration-controlled transient elastographys presented as a complementary imaging tool and a first-line assessment method for fibrosis staging, helping reduce reliance on liver biopsy.

l  HBsAg clearance is identified as the ideal treatment endpoint, and pegylated interferon alfa-based strategies in combination with nucleos(t)ide analogues are supported to optimize treatment timing and duration.

These updates closely align with the clinical areas where iLivTouch has continued to advance. As non-invasive fibrosis assessment becomes more central, iLivTouch remains well positioned to support guideline-based liver stiffness evaluation in CHB and to complement blood-based scores in routine practice. Its growing evidence base in HBV with metabolic comorbidities and in MASLD/MASH also reflects the guideline’s increasing focus on metabolic risk, while its potential use across special populations and full-course HBV management further underscores its relevance for both domestic and international populations.

Summary

The APASL 2026 revision reflects a more proactive CHB management strategy in a high-burden region.

Five priorities stand out: earlier treatment, metabolic comorbidity screening, non-invasive fibrosis assessment, special population management, and functional cure.

Vibration-controlled transient elastography is described as a complementary imaging tool and method in the guideline summary.

iLivTouch continues to expand its evidence base in CHB, HBV with metabolic comorbidities, MASLD/MASH, and broader non-invasive liver assessment.