Time for a globally unified chronic HBV terminology?

The terminology used to describe chronic hepatitis B (CHB) infection remains inconsistent and fragmented across liver societies, clinical settings, and research domains. This lack of alignment poses barriers to care, complicates clinical trial design, and can generate confusion among providers, people living with hepatitis B, and researchers. This article examines the impact of discordant CHB infection terminology on care delivery and research, highlighting specific challenges with commonly used terms, such as “immune tolerant,” “indeterminate” or “grey zone”, as well as with terms used for hepatitis B surface antigen loss, including “resolved infection”, “occult infection” or “functional cure.” Although recent guidelines have moved towards simplification, global uniformity remains lacking, particularly regarding definitions of disease phases and thresholds for initiating treatment. We call for alignment of terminology to improve care, increase treatment uptake, enhance patient engagement, and accelerate HBV research and elimination efforts. We propose a multistakeholder consensus process to create a unified and practical nomenclature that distinguishes between terminology for clinical care and terminology for research and drug development. We also call for intentional inclusion of people with lived experience in this process to ensure the language used is meaningful, empowering, and stigma-free. With the HBV field on the cusp of transformative therapies and simplified treatment algorithms, now is the time to harmonise the language we use. A globally unified chronic HBV infection terminology stands to enhance access to care, improve comparability of research data, and strengthen collaboration across the HBV community – all of which are critical to accelerating progress towards hepatitis B elimination.