When should I consider referring a patient with chronic Hepatitis B to a specialist for further management?

Refer all adults who are HBsAg positive to a hepatologist, gastroenterologist, or infectious disease specialist with an interest in hepatology, ideally within 6 weeks of diagnosis, especially if they have abnormal liver function tests or signs of liver disease ¹.

Refer adults with decompensated liver disease immediately to a specialist, as symptoms include ascites, encephalopathy, and gastrointestinal haemorrhage ¹.

Arrange specialist referral for children and young people who are HBsAg positive to a paediatric hepatologist or relevant specialist ¹.

Refer pregnant women who are HBsAg positive to a specialist within 6 weeks of screening for assessment and potential treatment in the third trimester ¹.

Consider referral if the patient has evidence of significant fibrosis or cirrhosis, or if they are at risk of hepatocellular carcinoma, such as those with HBV DNA ≥20,000 IU/ml and older than 40 years, or with a family history of HCC ¹.