丙型肝炎病毒(HBV)感染是一项重大的公共卫生问题，据估计，2019年全球有约2.96亿人患有慢性感染，820000人死亡。诊断HBV感染需要对HBsAg进行血清学测试，对急性感染需要额外测试IgM丙型肝炎病毒核心抗体（IgM anti-HBc，当HBsAg和抗-HBs均未检测到时为窗口期）。评估HBV复制状态以指导治疗决策需要进行HBV DNA测试，而评估肝病活动度和分期主要基于氨基转移酶、血小板计数和弹性成像。全面的婴儿免疫接种，包括出生时的疫苗接种，是预防慢性HBV感染最有效的手段。最近在美国和欧盟批准使用了两种免疫原性提高的疫苗，可望在更广泛的范围内得到推广。目前的疗法，包括聚乙二醇干扰素和核苷(t)酸类似物，可以预防肝硬化和肝细胞癌的发展，但不能根除病毒，很少能清除HBsAg。建议为肝硬化患者或HBV DNA水平高且有活动性或进展性肝病的患者进行治疗。新的抗病毒和免疫调节疗法旨在实现功能性治愈（即清除HBsAg），正在进行临床开发。改进疫苗接种覆盖率、增加筛查、诊断和患者关联，开发治愈疗法并消除污名是实现世界卫生组织在2030年消除HBV感染目标的重要举措。版权所有 © 2023 Elsevier Ltd.。保留所有权利。

Hepatitis B virus (HBV) infection is a major public health problem, with an estimated 296 million people chronically infected and 820 000 deaths worldwide in 2019. Diagnosis of HBV infection requires serological testing for HBsAg and for acute infection additional testing for IgM hepatitis B core antibody (IgM anti-HBc, for the window period when neither HBsAg nor anti-HBs is detected). Assessment of HBV replication status to guide treatment decisions involves testing for HBV DNA, whereas assessment of liver disease activity and staging is mainly based on aminotransferases, platelet count, and elastography. Universal infant immunisation, including birth dose vaccination is the most effective means to prevent chronic HBV infection. Two vaccines with improved immunogenicity have recently been approved for adults in the USA and EU, with availability expected to expand. Current therapies, pegylated interferon, and nucleos(t)ide analogues can prevent development of cirrhosis and hepatocellular carcinoma, but do not eradicate the virus and rarely clear HBsAg. Treatment is recommended for patients with cirrhosis or with high HBV DNA levels and active or advanced liver disease. New antiviral and immunomodulatory therapies aiming to achieve functional cure (ie, clearance of HBsAg) are in clinical development. Improved vaccination coverage, increased screening, diagnosis and linkage to care, development of curative therapies, and removal of stigma are important in achieving WHO's goal of eliminating HBV infection by 2030.Copyright © 2023 Elsevier Ltd. All rights reserved.