I. Pregnant women Pregnancy grading of hepatitis B antivirals: LAM, ADV, ETV: Grade C LdT, TDF: Grade B (1) Women of childbearing age with treatment indications prior to pregnancy Treatment with IFN or NAs should be applied prior to pregnancy as much as possible with a view to completing treatment in the first 6 months of pregnancy (China). Interferon therapy has a fixed course and IFN-a is available, but contraception is required during treatment (APASL). (For patients with CHB who require antiviral therapy during pregnancy, TDF or LdT antiviral therapy can be used (China); TDF is recommended as first-line by several guidelines due to more trial data. (3) Antiviral therapy during pregnancy reduces the risk of vertical transmission High serum HBeAg and HBV-DNA load in pregnant patients during immune tolerance is one of the high risk factors for mother-to-child transmission, and studies suggest that antiviral therapy can significantly reduce the incidence of mother-to-child transmission of HBV. Pregnant women not receiving antiviral therapy with HBV DNA load >2*10^6 IU/ml (China), >10^6~10^7 IU/ml (APASL, EASL), >2*10^5 IU/ml (AASLD) may be treated at week 24-28 (China) or week 28-32 (APASL, AASLD) of pregnancy based on adequate communication and informed consent with the patient. APASL, AASLD) or the last trimester (EASL) to start antiviral therapy. The WHO guidelines do not recommend routine antiviral therapy for prevention of mother-to-child transmission due to the lack of accumulated evidence. (4) Unplanned pregnancy during antiviral therapy Chinese guidelines recommend termination of pregnancy in patients with unplanned pregnancy during IFN-α antiviral therapy. Other guidelines only suggest changing IFN and NAs pregnancy class C drugs to NAs pregnancy class B drugs, without mentioning termination of pregnancy. However, because of the proliferation-inhibiting effect of IFN, contraception should be used during IFN treatment (APASL). (5) Reproductive toxicity of antiviral drugs in male patients Male patients treated with IFN-α should not be considered for fertility until 6 months after discontinuation of the drug. Male patients applying NAs antiviral therapy, there is no evidence of adverse effects of NAs treatment on sperm, and patients may be considered for fertility after adequate communication of the situation (China). Second, lactating women (1) Lactating women without antiviral therapy Although HBsAg can be detected in breast milk, there are no contraindications to breastfeeding as long as the newborn receives regular immunoprophylaxis. (2) Lactating women on antiviral therapy with NAs The level of breastfeeding for NAs has not been determined, the effect on the newborn is unknown, and several guidelines have not yet been agreed upon APASL does not recommend breastfeeding while taking the drug, and there is no explicit prohibition by WHO. Pediatric patients (<18 years of age) are often in the immune tolerance phase of HBV infection and are not usually considered for antiviral therapy. For those with abnormal liver function, prolonged cautious observation is needed to determine whether there is spontaneous serological conversion. For children with progressive liver disease or cirrhosis, antiviral therapy should be promptly administered, but the safety and resistance to long-term therapy need to be considered. (China) (1) Drug selection Drug indication population varies slightly among guidelines China: General IFN-α (2~17 years old), LAM (2~17 years old), ETV (2~17 years old), ADV (12~17 years old) and TDF (12~17 years old). 2~11 years old can be treated with IFN-α or ETV, 12~17 years old can be treated with IFN-α, ETV or TDF treatment. APASL: Common IFN-α >12 months, LAM >3 years, ADV or TDF >12 years, ETV >16 years. IFN-α is first recommended for children with HBeAg(+) because of the exact course of treatment. AASLD: IFN-α-2b >1 year, LAM >2 years, ETV >2 years, ADV >12 years, TDF >12 years. WHO: TDF or ETV is recommended for pediatric chronic hepatitis B patients >12 years of age with antiviral indication, ETV is recommended for 2-11 years of age. (2) Recommended dose The recommended dose for pediatric patients with IFN-α is 3-6 MU/m2 3 times per week. NAs drug LAM: 3 mg/kg qd Maximum dose: 100 mg qd Other: IV. Patients with renal insufficiency (1) Drug selection For patients with CHB who already have renal disorders and are at high risk, ADV or TDF should be avoided if possible. some studies suggest that LdT may have a role in improving GFR For patients with CHB who are at risk of renal impairment, treatment with LdT or ETV is recommended. IFN-α can be used in people with renal insufficiency (WHO) but not in transplant patients (APASL). TDF is not recommended in patients with Ccr <10 ml/min not on dialysis (WHO). Some drugs adjust the recommended dose according to renal function V. Application of chemotherapy and immunosuppressive populations All patients treated with chemotherapy and immunosuppressive drugs for other diseases should be routinely screened for HBsAg, anti-HBc and HBV DNA before starting treatment, and the degree of risk of receiving immunosuppressive drugs should be assessed. Grading of risk of HBV reactivation due to immunosuppressive drugs: Recommended China: HBsAg (+) or HBsAg (-)/anti-HBc (+) --- High/moderate risk immunosuppression: prophylactic antiviral, maintained at least until 6 months after finishing immunosuppressive therapy (at least 12 months for patients on B-lymphocyte activity inhibitors) --- Low risk immunosuppression: not recommended for routine Use of prophylactic antiviral therapy. Anti-Hbs(+)/anti-HBc (+) High- and intermediate-risk class immunosuppressants: closely monitor HBV serologic markers and HBV DNA APASL: HBsAg(+) Receive antiviral therapy and continue until 12 months after completion of chemotherapy or immunosuppressive therapy. HBsAg(-)/anti-HBc (+) Closely tested for HBV DNA levels EASL: Treatment with potent, low resistance nucleoside analogs is recommended for patients with high HBVDNA levels or for patients who require long-term repeated immunosuppressive therapy. Prophylactic antiviral therapy with lamivudine is recommended for patients with hematologic malignancies treated with rituximab who are HBsAg(-)/anti-HBc (+) and have anti-HBs(-) and are unable to monitor HBV DNA levels regularly. For patients with bone marrow transplantation or stem cell transplantation, lifelong prophylactic antiviral therapy is recommended after liver transplantation from the donor as long as anti-HBc (+). VI. Liver transplantation population (1) NAs Early treatment with nucleoside (acid) analogs with strong HBV inhibition and low incidence of drug resistance to obtain the lowest possible viral load and prevent reinfection of the transplanted liver; lifelong antiviral drug application is required. APASL: Use of ETV or TDF to reduce HBV DNA levels to non-detectable before transplantation (2) HBIG China --Patients at low risk of HBV reinfection in the transplanted liver (pre-transplant HBVDNA non-detectable): No need for HBIG. --Patients at high risk of HBV reinfection in the transplanted liver (pre-transplant HBVDNA detectable, HBV resistant patients, co-infected with HIV, HDV. Pre-transplant hepatocellular carcinoma patients, patients with poor compliance): HBIG given during the intraoperative liver-free phase, the main post-transplant antiviral regimen is NAs combined with low-dose HBIG APASL: 10,000 IU IV during the liver-free phase in high-risk patients; then 600-1000 IU IM/IV qd*7 days; followed by 600-1000 IU IV/IM qw*3 weeks; Subsequent monthly use for 1 year with regular HBsAb level testing to maintain HbsAb>100 mIU/ml for 1 year, which can be discontinued after 1 year.