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 NICE CKS.
Refer adults with decompensated liver disease immediately to a specialist, as symptoms include ascites, encephalopathy, and gastrointestinal haemorrhage NICE CKS.
Arrange specialist referral for children and young people who are HBsAg positive to a paediatric hepatologist or relevant specialist NICE CKS.
Refer pregnant women who are HBsAg positive to a specialist within 6 weeks of screening for assessment and potential treatment in the third trimester NICE CKS.
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 NICE CKS.