Navigating the landscape of hepatitis B virus reactivation in HBsAg-positive and HBsAg-negative resolved infections: Current insights and future directions.

Hepatitis B virus (HBV) infection remains a global public health burden, despite widespread vaccination programs. Although vaccination has drastically reduced transmission, millions of individuals with past or chronic HBV infection are susceptible to reactivation, particularly under immunosuppression. This review examines recent clinical studies exploring HBV reactivation, focusing on risk assessment, screening challenges, preventative strategies, early detection, and optimal management approaches. We discuss varied clinical presentations of reactivation, ranging from asymptomatic to severe hepatitis, and highlight the critical role of identifying risk factors for the timely initiation of antiviral prophylaxis and treatment. Recent advancements in medications, novel biomarkers, and comprehensive management strategies are explored, emphasising the importance of early detection and optimal management to prevent reactivation-related complications. This review also addresses challenges in global HBV elimination, emphasising the need for improved vaccination coverage, early diagnosis, and accessible healthcare to achieve effective control and reduce the burden of HBV and its complications.