Lifestyle Medicine and Chronic Hepatitis B in Viet Nam: Alcohol Avoidance, Antiviral Treatment, and Liver Cancer Surveillance

Lifestyle Medicine and Chronic Hepatitis B in Viet Nam: Alcohol Avoidance, Antiviral Treatment, and Liver Cancer Surveillance

Primary category: Evidence & Clinical Practice

Secondary category: Lifestyle Medicine in Viet Nam

Article type: VLMA Perspective

Last reviewed: October 30, 2026

A person living with chronic hepatitis B may feel well for years. They continue working, exercising, and enjoying everyday activities without obvious signs of liver disease. Their routine liver enzyme tests may also remain within the normal range.

These findings may be reassuring, but they do not necessarily mean that the infection requires no further attention. Someone may decide to stop drinking alcohol, eat more healthfully, and return for medical care only if symptoms develop.

The difficulty is that chronic hepatitis B can progress without noticeable warning signs. Significant liver fibrosis may develop while a person feels healthy, and the risk of liver cancer can persist even when antiviral treatment has successfully suppressed viral replication.

This creates an important distinction for Lifestyle Medicine. Avoiding alcohol, maintaining appropriate nutrition, staying physically active, and addressing metabolic risk factors can contribute to long-term health. However, chronic hepatitis B is a viral infection. These behaviors do not eliminate the virus, replace indicated antiviral treatment, or remove the need for clinical monitoring.

For healthcare professionals in Viet Nam, the challenge is to connect lifestyle-related support with comprehensive hepatitis B care. This includes assessing liver disease, identifying patients who need antiviral treatment, monitoring for complications, preventing transmission, and helping people remain connected to healthcare over time.

The Ministry of Health's updated hepatitis B guideline, issued in June 2026, provides an important national reference. Together with recent international recommendations, it reinforces why effective management depends on more than symptoms, liver enzyme results, or the quality of a person's daily habits.

For the Vietnam Lifestyle Medicine Alliance (VLMA), chronic hepatitis B offers an opportunity to examine how evidence-based Lifestyle Medicine can support people living with chronic infection while recognizing the clinical responsibilities that cannot be replaced by lifestyle interventions.

Chronic Hepatitis B Can Progress Without Obvious Symptoms

Hepatitis B is caused by the hepatitis B virus, which infects liver cells and can lead to chronic inflammation, progressive fibrosis, cirrhosis, and hepatocellular carcinoma, the most common type of primary liver cancer.

The clinical course varies considerably between individuals. Some people have relatively low viral activity and stable liver findings for extended periods, while others experience ongoing viral replication, inflammation, or progressive fibrosis. These patterns may also change over time.

A person with chronic hepatitis B may therefore have clinically important liver disease despite feeling healthy. Conversely, elevated liver enzymes can reflect several contributing conditions, including viral hepatitis, metabolic dysfunction, alcohol-related injury, medication-related liver injury, or a combination of these factors.

A single liver enzyme result cannot establish the severity of chronic hepatitis B or determine whether treatment is necessary.

Clinical evaluation may involve hepatitis B surface antigen, hepatitis B e antigen, hepatitis B virus DNA, liver enzymes, platelet count, assessment of liver fibrosis, and investigations for relevant coinfections or associated conditions.

A positive hepatitis B surface antigen result indicates current infection, but it does not independently establish whether the infection is acute or chronic. Previous test results, medical history, and additional investigations may be required to characterize the infection and determine appropriate management.

Assessment of liver fibrosis is particularly important. Noninvasive methods, including serum-based fibrosis scores and liver elastography, may help identify clinically significant fibrosis or cirrhosis.

The Ministry of Health's 2026 guideline recognizes that normal alanine aminotransferase levels do not automatically exclude significant fibrosis or the need for antiviral treatment.

This has an important implication for patient communication. Rather than offering reassurance solely because someone feels well or has normal liver enzymes, healthcare professionals need to explain what is known about the infection, whether further assessment is necessary, and how the person's risk may change over time.

Viet Nam's 2026 Hepatitis B Guideline: What Has Changed?

On June 16, 2026, the Ministry of Health issued Decision No. 1740/QĐ-BYT, promulgating the updated professional document Guidelines for Diagnosis and Treatment of Hepatitis B Virus Infection.

The decision took effect on the date of issuance, applies to medical examination and treatment facilities nationwide, and replaced Decision No. 3310/QĐ-BYT dated July 29, 2019.

The updated guideline reflects developments in hepatitis B testing, assessment of liver fibrosis, antiviral treatment eligibility, management of coinfections and comorbidities, long-term monitoring, and prevention of hepatitis B reactivation.

One important development is the emphasis on expanding early detection of hepatitis B infection. The guideline recommends that people living in Viet Nam undergo testing for hepatitis B infection, with hepatitis B surface antigen as the minimum screening test and additional serological testing when appropriate and available.

This is relevant because people may live with chronic infection for years without symptoms and may first become aware of their infection through routine or preventive testing.

Another significant development concerns antiviral treatment eligibility.

For adults and adolescents aged 12 years and older, the guideline includes clinically significant liver fibrosis or cirrhosis among treatment indications, regardless of hepatitis B virus DNA or alanine aminotransferase levels.

Other criteria consider viral replication, liver enzyme findings, relevant coinfections, metabolic comorbidities, immunosuppression, extrahepatic manifestations, and family history of cirrhosis or liver cancer.

These criteria require appropriate clinical assessment and interpretation within the complete guideline. They should not be presented as a simplified treatment algorithm for patients to apply independently.

Nevertheless, the clinical implication is important. Waiting for substantial symptoms or persistently abnormal liver enzymes may delay appropriate treatment in some individuals.

A person who does not currently meet treatment criteria also needs a follow-up plan. Viral activity, fibrosis, and clinical circumstances can change, and treatment eligibility may need to be reconsidered.

International guidance has evolved in parallel.

In February 2026, the World Health Organization published a consolidated implementation handbook addressing hepatitis B and C prevention, testing, treatment, service delivery, and monitoring. The Asian Pacific Association for the Study of the Liver also published updated clinical practice guidelines for chronic hepatitis B in 2026.

These developments are taking place against a substantial global disease burden.

According to the World Health Organization's Global Hepatitis Report 2026, approximately 240 million people were living with chronic hepatitis B worldwide in 2024. Hepatitis B caused an estimated 1.1 million deaths that year, largely through cirrhosis and liver cancer.

The report also estimated that only 27% of people living with chronic hepatitis B had been diagnosed and approximately 4.3% were receiving treatment.

These figures illustrate the continuing gap between the availability of effective treatment and the number of people receiving care.

International recommendations provide important scientific evidence, but their implementation in Viet Nam must be considered alongside national professional guidance, approved treatments, available services, and individual clinical circumstances.

Avoiding Alcohol Matters, but It Is Not Antiviral Treatment

Alcohol can contribute to liver injury and compound the risks associated with chronic viral hepatitis.

For people living with hepatitis B, harmful alcohol consumption may increase the likelihood of progressive fibrosis, cirrhosis, and hepatocellular carcinoma. Avoiding alcohol is therefore an important part of reducing additional liver-related harm.

Viet Nam's 2026 hepatitis B guideline recommends avoiding alcohol or minimizing consumption as much as possible.

The expected benefits of this advice need to be communicated accurately.

Stopping alcohol consumption does not suppress hepatitis B viral replication in the same way that antiviral medication does. It does not eliminate the virus, reliably reverse established cirrhosis, or remove the possibility of liver cancer.

Someone who has stopped drinking still needs appropriate evaluation of viral activity, fibrosis, treatment eligibility, and long-term complications.

The reverse is also true. A person receiving effective antiviral treatment should not assume that viral suppression removes the additional risks associated with harmful alcohol consumption.

These interventions address different aspects of liver health and should be understood as complementary rather than interchangeable.

Alcohol counseling also needs to reflect the person's circumstances. Someone who drinks occasionally may require a different approach from a person with alcohol dependence. For individuals with significant dependence, abruptly stopping alcohol can lead to dangerous withdrawal and may require medical supervision.

Respectful communication is particularly important because discussions about alcohol can easily become judgmental. Understanding the person's drinking pattern, clinical risks, and available support is more useful than attributing liver disease to personal choices.

For patients with cirrhosis or advanced liver disease, abstinence is particularly important. More broadly, avoiding alcohol should be presented as a measure to reduce additional liver injury, not as a treatment that controls hepatitis B infection itself.

Nutrition, Physical Activity, and Metabolic Health

Healthy eating and appropriate physical activity can contribute to long-term health in people living with chronic hepatitis B.

Their benefits may be particularly relevant when the person also has obesity, type 2 diabetes, hypertension, dyslipidemia, or metabolic dysfunction-associated steatotic liver disease.

These conditions may contribute additional health risks and influence the overall management of chronic liver disease.

For example, someone with chronic hepatitis B and hepatic steatosis may require antiviral treatment based on hepatitis B-related risks while receiving separate support for metabolic health.

The presence of fatty liver should not lead clinicians to overlook viral hepatitis. Similarly, a diagnosis of chronic hepatitis B should not prevent appropriate assessment and management of cardiometabolic conditions.

Evidence that dietary interventions benefit metabolic health should not automatically be interpreted as proof that a particular diet suppresses hepatitis B viral replication or prevents hepatocellular carcinoma.

Likewise, physical activity can improve fitness, muscle strength, metabolic health, and psychological well-being, but it does not replace indicated antiviral treatment.

The Ministry of Health's 2026 guideline recommends appropriate nutrition and maintaining a suitable body weight.

The practical meaning depends on the person's clinical condition.

For someone without advanced liver complications, a balanced dietary pattern supporting general health is usually more appropriate than a restrictive diet promoted specifically for hepatitis B.

For patients with advanced cirrhosis, malnutrition, poor appetite, or loss of muscle mass, nutritional needs may be substantially different.

General recommendations to lose weight or restrict protein can be inappropriate and potentially harmful in these circumstances.

Physical activity also requires individualization. People with stable chronic liver disease may benefit from suitable exercise, while those with significant fatigue, sarcopenia, ascites, or other complications may require additional clinical assessment and modified activities.

For Lifestyle Medicine, the objective is to support physical functioning, metabolic health, and sustainable behaviors without suggesting that the course of chronic viral infection depends primarily on how well someone follows lifestyle advice.

Why Liver Detox Products Deserve Scrutiny

People living with chronic liver disease may encounter advertisements for products described as cleansing, detoxifying, repairing, or regenerating the liver.

Some products are promoted as natural alternatives to antiviral medication, with suggestions that the liver can recover if the person follows a particular diet or takes certain supplements.

These claims require careful scientific evaluation.

There is no established evidence that commercially marketed liver detoxification products eradicate hepatitis B virus or replace indicated antiviral treatment.

Some herbal preparations and dietary supplements can also cause liver injury or interact with prescribed medicines.

This does not mean that every herbal product is harmful. It means that safety and effectiveness must be evaluated for the specific product, formulation, dose, and clinical situation.

The Ministry of Health's 2026 guideline advises caution with medicines that may cause liver injury and with herbal products or supplements of uncertain origin.

Patients should be encouraged to inform their treating healthcare professionals about all medicines and supplements they use, including products obtained without a prescription.

Necessary conventional medicines should not automatically be avoided simply because a person has hepatitis B. Medication decisions require consideration of the clinical indication, liver function, potential adverse effects, interactions, and available alternatives.

The concern is that an unproven product may create false reassurance or delay necessary investigation and treatment.

For professional education, scientific independence is important. Educational content should help healthcare professionals and patients understand the available evidence without promoting commercial supplements or accepting claims merely because a product is described as natural.

Antiviral Treatment Addresses the Underlying Viral Risk

The principal objective of antiviral treatment in chronic hepatitis B is to suppress viral replication and reduce the risk of progressive liver disease and serious complications.

Viet Nam's 2026 guideline identifies oral nucleoside or nucleotide analogues as the usual initial treatment approach for eligible patients.

Established options include tenofovir disoproxil fumarate, tenofovir alafenamide, and entecavir.

Selection depends on the patient's clinical condition, kidney function, bone health, pregnancy-related considerations, previous antiviral exposure, associated diseases, and other relevant factors.

These medicines are not necessarily interchangeable across patients.

In appropriately selected individuals, antiviral treatment can achieve sustained suppression of hepatitis B virus DNA and substantially reduce the risk of progressive liver disease.

However, suppression is not the same as eradication.

Current antiviral treatment generally does not eliminate the persistent viral reservoirs that allow hepatitis B infection to continue or potentially reactivate.

Loss of hepatitis B surface antigen, often described as a functional cure when appropriately confirmed, is an important treatment outcome but remains relatively uncommon with currently available therapies.

For many patients, treatment continues for years and may be indefinite.

Patients with cirrhosis or other high-risk clinical circumstances often require long-term treatment. In selected patients without cirrhosis, treatment discontinuation may be considered only when defined clinical criteria are satisfied and reliable follow-up is available.

The Vietnamese guideline includes specific conditions for considering treatment discontinuation and monitoring after treatment has stopped.

These decisions require specialist assessment. A normal liver enzyme result, an undetectable viral load during treatment, or improvement in lifestyle does not independently establish that medication can be stopped safely.

Inappropriate interruption can lead to renewed viral replication, hepatitis flares, and serious liver deterioration.

Lifestyle Medicine can help patients maintain general health, understand their treatment, and address practical barriers to ongoing care. Reducing antiviral medication should not be presented as an objective of lifestyle intervention.

Long-Term Treatment Depends on Continuity of Care

Effective antiviral treatment requires more than issuing a prescription.

Patients need continuing access to medication, appropriate monitoring, and a clear understanding of why treatment and follow-up remain necessary.

Someone may understand the importance of antiviral treatment but struggle to attend appointments because of work commitments or travel distance. Another person may encounter difficulties obtaining medication after moving or changing healthcare providers.

Some patients stop treatment because they feel healthy or misunderstand what an undetectable viral load means. Others are concerned about long-term adverse effects or the financial burden of continuing care.

These concerns deserve explanation and practical support rather than criticism.

The Ministry of Health's 2026 guideline emphasizes counseling before treatment and throughout follow-up. Patients should understand the purpose of medication, expected benefits, possible adverse effects, monitoring requirements, and the consequences of inappropriate interruption.

The World Health Organization's 2026 implementation handbook similarly emphasizes person-centered care, retention in treatment services, and approaches that can improve continuity.

Medication safety requires continuing clinical review.

Depending on the antiviral regimen and the patient's condition, monitoring may include liver enzymes, viral load, kidney function, and selected assessments of bone or metabolic health.

The objective is to maintain effective viral suppression while identifying changes in liver disease or treatment-related problems early.

Healthcare organizations can contribute through reliable appointment arrangements, clear responsibilities for follow-up, medication review, and appropriate communication when care is transferred.

A prescription recorded in the medical record does not establish that the patient obtained the medicine or continued treatment successfully.

For chronic hepatitis B, continuity of care is an essential part of treatment effectiveness.

Liver Cancer Risk Can Persist Despite Viral Suppression

One of the most important long-term concerns in chronic hepatitis B is hepatocellular carcinoma.

Antiviral treatment reduces the risk of liver-related complications, but it does not eliminate every possibility of liver cancer.

Residual risk is particularly important among people with cirrhosis, advanced fibrosis, relevant family histories, or other established risk factors.

Hepatocellular carcinoma can also develop in some people with chronic hepatitis B who do not have cirrhosis.

This is why monitoring hepatitis B virus DNA and assessing liver cancer risk are related but distinct responsibilities.

A patient with an undetectable viral load may still require continued liver cancer surveillance. Similarly, loss of hepatitis B surface antigen does not automatically remove the need for surveillance in everyone.

The updated American Association for the Study of Liver Diseases and Infectious Diseases Society of America guideline, published online in November 2025 and in its final journal issue in 2026, includes recommendations concerning surveillance after hepatitis B surface antigen loss.

It identifies selected groups in whom surveillance may remain appropriate, including people with cirrhosis, a family history of hepatocellular carcinoma, men who experienced surface antigen loss after age 40, and women who experienced it after age 50.

These recommendations are conditional and supported by evidence of very low certainty. They nevertheless reinforce the principle that improvements in virological markers do not always eliminate long-term cancer risk.

For patients, this distinction is important.

A suppressed viral load is a meaningful success of treatment. It reduces important risks but does not guarantee that liver cancer cannot develop.

Long-term management therefore needs to consider both the benefits achieved through antiviral therapy and the risks that remain.

Liver Cancer Surveillance: Reading Vietnamese and International Guidance Carefully

Hepatocellular carcinoma surveillance aims to identify potentially treatable cancer at an earlier stage in people whose risk justifies regular examination.

International recommendations commonly use a risk-based approach.

The World Health Organization's 2024 chronic hepatitis B guideline recommends abdominal ultrasound combined with alpha-fetoprotein testing every six months for defined higher-risk populations.

These include people with cirrhosis, those with a family history of hepatocellular carcinoma, and certain other people without cirrhosis who meet specified age and virological risk criteria.

The European Association for the Study of the Liver and the American Association for the Study of Liver Diseases also provide risk-based recommendations for liver cancer surveillance.

However, the Vietnamese Ministry of Health's 2026 guideline contains monitoring provisions that need to be interpreted carefully.

In Section 4.3.1, concerning people who do not yet meet criteria for antiviral treatment, the guideline describes early detection of hepatocellular carcinoma using ultrasound and tumor markers at intervals of 24–48 weeks, according to the patient's risk.

For patients receiving antiviral treatment, the monitoring table in Section 4.3.2 describes abdominal ultrasound every 12–24 weeks and tumor marker testing at specified intervals.

A subsequent general note in the same section states that people with hepatitis B infection, whether untreated, currently receiving antiviral treatment, or having discontinued treatment, need examinations for early detection of hepatocellular carcinoma every 12–24 weeks.

These provisions do not express an identical monitoring interval.

The appropriate approach is not to disregard one passage or assume that an international six-month schedule automatically replaces Vietnamese professional guidance.

Healthcare professionals should consider the relevant sections together, the patient's clinical condition, treatment status, and cancer risk, and any applicable professional or institutional clarification when establishing a surveillance plan.

This distinction is important because surveillance intervals are clinical decisions, not general lifestyle recommendations.

The national guideline also discusses tumor markers including alpha-fetoprotein, alpha-fetoprotein-L3, and protein induced by vitamin K absence or antagonist-II.

The availability of these tests depends on healthcare facility resources and clinical circumstances. They should not be assumed to have identical diagnostic performance or to be interchangeable.

It is also important to understand the limitations of surveillance.

An elevated alpha-fetoprotein level does not establish hepatocellular carcinoma on its own. Conversely, a normal result does not reliably exclude liver cancer.

Ultrasound performance can be affected by body habitus, liver characteristics, and technical factors.

When surveillance identifies a suspicious lesion or another concerning finding, appropriate diagnostic imaging and specialist assessment may be necessary.

Surveillance has potential benefits, but it can also produce false-positive findings, additional investigations, anxiety, and costs.

Its purpose is not to perform as many tests as possible. It is to provide clinically appropriate monitoring and ensure that concerning findings lead to timely diagnostic action.

For healthcare organizations, quality depends on whether patients receive examinations according to an appropriate clinical plan and whether abnormal results are followed up reliably.

Hepatitis B Reactivation Is a Safety Concern Across Specialties

Hepatitis B management extends beyond hepatology and infectious disease services.

People with current or previous hepatitis B infection may require chemotherapy, prolonged systemic corticosteroid treatment, biologic therapies, transplantation, or other forms of immunosuppression.

These treatments can increase the risk of hepatitis B reactivation.

Reactivation may occur in people with current infection and, under certain circumstances, in those with evidence of previous infection.

The resulting hepatitis flare may be severe and can interrupt essential treatment for another medical condition.

Viet Nam's 2026 hepatitis B guideline addresses assessment and prevention of reactivation before immunosuppressive therapy, chemotherapy, and transplantation.

Its appendix distinguishes different levels of risk and describes approaches involving antiviral prophylaxis or monitoring according to the clinical situation.

Management depends on hepatitis B serological status, the type and intensity of immunosuppression, and other relevant factors.

Not every patient receiving an immunosuppressive medicine requires the same preventive regimen.

However, failure to recognize hepatitis B risk before treatment can lead to avoidable harm.

For example, someone receiving treatment for rheumatoid arthritis, lymphoma, or another malignancy may require hepatitis B testing and a prevention plan coordinated between the treating specialist and the clinician responsible for liver care.

This is an important example of interdisciplinary patient safety.

Decisions made in oncology, hematology, rheumatology, transplantation, or other clinical specialties may affect a patient's liver health, even when liver disease is not the primary reason for treatment.

Lifestyle changes cannot reliably prevent hepatitis B reactivation associated with significant immunosuppression. Appropriate medical assessment, antiviral prophylaxis when indicated, and monitoring remain essential.

Prevention, Vaccination, and Stigma-Free Care

Chronic hepatitis B care also involves preventing transmission and protecting people from unnecessary stigma.

Hepatitis B can be transmitted through infected blood and certain other body fluids, including during childbirth, sexual exposure, unsafe injections, and procedures involving contaminated instruments.

It is not transmitted through ordinary social contact such as sharing meals, hugging, coughing, or using the same eating utensils.

These distinctions matter because misunderstanding of transmission can lead to unnecessary fear and discrimination.

People living with hepatitis B should receive accurate information about prevention without being treated as a risk during ordinary social interactions.

Viet Nam's 2026 guideline includes counseling about testing relevant contacts, vaccination of susceptible individuals, and avoiding the sharing of personal items that may be contaminated with blood.

Household members and sexual partners may benefit from appropriate testing and vaccination according to their circumstances.

Prevention of mother-to-child transmission is another important responsibility.

The World Health Organization's 2026 implementation handbook emphasizes maternal screening, timely hepatitis B birth-dose vaccination, and additional interventions when clinically indicated.

Viet Nam's 2026 guideline also addresses maternal care and refers to Decision No. 678/QĐ-BYT dated February 26, 2025, concerning technical interventions to prevent mother-to-child transmission of human immunodeficiency virus, hepatitis B, and syphilis.

These interventions require appropriate maternal, neonatal, and infectious disease care. Decisions about maternal antiviral treatment and infant preventive measures should follow the relevant national professional guidance.

The presence of hepatitis B infection should not be interpreted as evidence of irresponsible behavior.

Many people acquire the infection at birth or during childhood, long before they have any control over exposure.

Stigma may discourage testing, disclosure to healthcare professionals, and attendance at follow-up appointments.

Respectful communication, accurate information, and confidentiality are therefore important components of both individual care and prevention.

Strengthening the Continuum of Hepatitis B Care in Viet Nam

A central message of the World Health Organization's 2026 implementation handbook is that effective hepatitis services need to connect prevention, testing, treatment, monitoring, and long-term care.

For Vietnamese healthcare organizations, this provides a useful way to examine what happens after someone receives a positive hepatitis B test result.

The person needs more than notification that the test is abnormal. They need an explanation of the result, appropriate further assessment, and a clear understanding of what happens next.

Depending on clinical circumstances, additional evaluation may involve hepatitis B serological markers, viral load, fibrosis assessment, medical history, and review of relevant family risks.

Coinfections also deserve attention.

The Ministry of Health's 2026 guideline includes assessment for hepatitis C and human immunodeficiency virus, together with hepatitis D testing when appropriate and available.

For hepatitis D, the guidance describes antibody testing in people who are hepatitis B surface antigen positive when testing is available, followed by hepatitis D virus RNA testing when indicated.

Identifying coinfections can alter treatment decisions, monitoring requirements, and long-term risk assessment.

Once the initial evaluation is complete, the clinician needs to determine whether antiviral treatment is indicated and establish an appropriate follow-up plan.

If treatment is not currently required, the patient should understand why monitoring remains necessary and what may lead to reassessment.

If medication is initiated, follow-up should address viral response, treatment safety, medication access, and continuity.

For patients requiring liver cancer surveillance, the care plan should also ensure that examinations are arranged and abnormal findings are acted upon.

Different healthcare settings may contribute in different ways.

A hospital with specialist liver services may provide comprehensive investigations and treatment. A smaller facility may focus on identifying patients, arranging appropriate initial assessment, providing education within its capabilities, and referring when necessary.

The objective is not to duplicate specialist services at every level of healthcare.

It is to ensure that patients can move between services without losing essential clinical information or access to necessary care.

Digital reminders, patient education materials, and structured follow-up systems may help when appropriately implemented, but their effectiveness should be evaluated rather than assumed.

These systems should also remain accessible to patients who have limited digital literacy, unreliable connectivity, or difficulty using mobile applications.

Measuring Quality Beyond Viral Suppression

Hepatitis B care can be evaluated through laboratory results, but effective long-term management involves more than a suppressed viral load.

For patients receiving antiviral therapy, hepatitis B virus DNA levels and other relevant markers help assess treatment response.

Monitoring liver disease progression, medication safety, and treatment continuity provides additional information.

For patients who do not currently require medication, quality includes appropriate monitoring and timely reassessment when clinical circumstances change.

For patients receiving hepatocellular carcinoma surveillance, quality includes completing the relevant examinations and ensuring follow-up of suspicious findings.

Healthcare organizations may also examine whether indicated assessments for hepatitis D or other coinfections have been performed and whether hepatitis B status is considered before immunosuppressive treatment.

These are important aspects of clinical safety that are not captured by viral load results alone.

Patient experience also matters.

Someone who understands their condition and treatment plan may be better able to participate in decisions and remain connected to care.

A person who struggles to obtain medication, experiences stigma, or does not understand why monitoring is necessary may face barriers that routine clinical indicators do not reveal.

Quality improvement should therefore connect clinical outcomes with the reliability of the care process.

Counting the number of patients who received nutrition or alcohol counseling does not establish whether hepatitis B was managed appropriately.

Likewise, recording successful viral suppression does not demonstrate that liver cancer surveillance occurred according to the clinical plan.

The more meaningful question is whether patients received the assessment, treatment, monitoring, and support appropriate to their clinical condition.

This requires clear professional responsibilities, reliable follow-up, and attention to the practical circumstances affecting access to care.

Professional and Legal Responsibilities in Viet Nam

Lifestyle Medicine can contribute to chronic hepatitis B care through evidence-based education, appropriate nutritional support, alcohol avoidance, physical activity, metabolic risk management, and attention to factors influencing long-term health.

However, diagnosing hepatitis B, interpreting viral markers, assessing liver fibrosis, determining antiviral treatment eligibility, prescribing medicines, and deciding on liver cancer surveillance are regulated clinical activities.

In Viet Nam, these responsibilities are governed by the Law on Medical Examination and Treatment No. 15/2023/QH15, as amended, and its applicable implementing regulations.

Consolidated Document No. 26/VBHN-VPQH dated February 26, 2026, provides an updated consolidated reference to this law.

The Law on Disease Prevention No. 114/2025/QH15, effective July 1, 2026, provides a broader framework for communicable and noncommunicable disease prevention and health promotion.

These laws do not create independent authority to provide regulated clinical services through Lifestyle Medicine education, professional membership, or international certification.

Healthcare professionals must act within their qualifications, competence, and legally authorized scopes of practice.

The Ministry of Health's Decision No. 1740/QĐ-BYT is the national professional document specifically addressing hepatitis B diagnosis and treatment as of October 30, 2026.

International recommendations provide valuable scientific references, but they should not automatically be interpreted as replacing the professional requirements applicable in Viet Nam.

Confidentiality is another important responsibility.

Hepatitis B status, viral load results, liver investigations, and related clinical information can constitute sensitive personal data.

The Law on Personal Data Protection No. 91/2025/QH15 and Government Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, establish relevant requirements concerning the processing and protection of personal information.

Healthcare organizations collecting or sharing identifiable patient data must consider applicable legal bases, confidentiality obligations, security measures, retention requirements, and relevant permissions.

Professional educational activities should avoid using identifiable clinical examples without an appropriate legal basis and necessary safeguards.

For VLMA, the appropriate role is to support understanding of scientific evidence and its practical implications without presenting educational content as individualized medical advice or an official clinical guideline.

Implications for the Vietnam Lifestyle Medicine Alliance

Chronic hepatitis B illustrates why evidence-based Lifestyle Medicine needs to remain connected to established medical care.

Alcohol avoidance, appropriate nutrition, physical activity, and metabolic risk management can improve overall health and may reduce additional liver-related risks.

These interventions are valuable, but they cannot replace assessment of viral infection, indicated antiviral treatment, monitoring for disease progression, or prevention and surveillance of serious complications.

For VLMA, an appropriate contribution is to support healthcare professionals in understanding these distinctions through evidence-based education, scientific knowledge exchange, and responsible collaboration.

Relevant educational topics may include alcohol avoidance in chronic liver disease, the relationship between hepatitis B and metabolic health, treatment adherence, patient communication, and the importance of maintaining appropriate surveillance.

Professional discussions could also examine the management of hepatitis B across different clinical services, particularly the prevention of reactivation during immunosuppressive treatment and prevention of mother-to-child transmission.

Such work would benefit from collaboration with qualified specialists in hepatology, infectious diseases, and other relevant clinical fields.

VLMA is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. Its activities focus on evidence-based professional education, capability development, scientific knowledge exchange, and collaboration.

VLMA does not independently diagnose hepatitis B, prescribe antiviral medication, determine individual treatment eligibility, interpret liver investigations for clinical decisions, or operate a hepatocellular carcinoma surveillance service.

Its intended contribution is to strengthen professional understanding and support responsible interpretation of evidence within authorized healthcare services.

Healthy Living and Long-Term Hepatitis B Care Belong Together

Living with chronic hepatitis B does not necessarily mean feeling ill.

Someone may remain active, work normally, eat well, and have no noticeable symptoms while still needing treatment or regular monitoring.

A healthy lifestyle can support liver health and overall well-being. Avoiding alcohol, maintaining appropriate nutrition, staying physically active when suitable, and managing metabolic conditions all have value.

However, the underlying infection requires its own assessment and management.

Some people need long-term antiviral medication. Others require continued monitoring until treatment becomes appropriate. Liver cancer surveillance remains an important component of care under applicable professional guidance, even when viral replication has been effectively suppressed.

The updated Vietnamese guideline and international evidence available in 2026 reinforce the importance of identifying people who need care, maintaining treatment continuity, preventing transmission, and recognizing complications before they become advanced.

For healthcare professionals in Viet Nam, the opportunity is not to promote lifestyle changes as an alternative treatment for chronic hepatitis B.

It is to integrate appropriate lifestyle support into a reliable care pathway connecting prevention, diagnosis, antiviral treatment, monitoring, cancer surveillance, and patient-centered communication.

Success should not be measured solely by whether someone has stopped drinking alcohol or adopted a healthier diet.

It should also be measured by whether that person understands their condition, receives appropriate treatment and monitoring, remains connected to necessary services, and has the best achievable opportunity to avoid serious liver complications.

Lifestyle Medicine can support healthier living with chronic hepatitis B, but effective long-term care still depends on appropriate antiviral treatment, clinical monitoring, liver cancer surveillance, and prevention of transmission.

Selected References

1. Ministry of Health of Viet Nam. Decision No. 1740/QĐ-BYT Issuing the Guidelines for Diagnosis and Treatment of Hepatitis B Virus Infection. June 16, 2026.

2. World Health Organization. Global Hepatitis Report 2026. Geneva: World Health Organization; 2026. ISBN: 978-92-4-012238-3.

3. World Health Organization. Consolidated Guidance on Hepatitis B and C Prevention, Testing, Treatment, Service Delivery and Monitoring: An Implementation Handbook for a Public Health Approach. Geneva: World Health Organization; 2026. ISBN: 978-92-4-011952-9.

4. World Health Organization. Guidelines for the Prevention, Diagnosis, Care and Treatment for People With Chronic Hepatitis B Infection. March 2024.

5. World Health Organization. Hepatitis B. Fact sheet. Updated July 28, 2026.

6. You H, Maiwall R, Chen J, et al. APASL Clinical Practice Guidelines on the Management of Chronic Hepatitis B Infection: A 2026 Update. Hepatology International. 2026;20(4):911–942. DOI: 10.1007/s12072-026-11108-1.

7. Ghany MG, Pan CQ, Lok AS, et al. AASLD/IDSA Practice Guideline on Treatment of Chronic Hepatitis B. Hepatology. 2026;83(4):974–997. DOI: 10.1097/HEP.0000000000001549.

8. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the Management of Hepatitis B Virus Infection. Journal of Hepatology. 2025;83(2):502–583. DOI: 10.1016/j.jhep.2025.03.018.

9. Singal AG, Llovet JM, Yarchoan M, et al. AASLD Practice Guidance on Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma. Hepatology. 2023;78(6):1922–1965. DOI: 10.1097/HEP.0000000000000466.

10. US Centers for Disease Control and Prevention. Hepatitis B Prevention and Control. Updated January 31, 2025.

11. Ministry of Health of Viet Nam. Decision No. 678/QĐ-BYT Issuing Technical Guidelines for Interventions to Prevent Mother-to-Child Transmission of HIV, Hepatitis B and Syphilis. February 26, 2025.

12. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH: Law on Medical Examination and Treatment. February 26, 2026.

13. National Assembly of Viet Nam. Law on Disease Prevention No. 114/2025/QH15. December 10, 2025. Effective July 1, 2026.

14. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. June 26, 2025. Effective January 1, 2026.

15. Government of Viet Nam. Decree No. 356/2025/NĐ-CP Detailing Selected Provisions and Implementation Measures of the Law on Personal Data Protection. December 31, 2025. Effective January 1, 2026.

16. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443–451. DOI: 10.1177/15598276251379821.

Editorial and Professional Scope Note

This article presents an educational and professional perspective of the Vietnam Lifestyle Medicine Alliance on the contribution and limitations of evidence-based Lifestyle Medicine in chronic hepatitis B care, based on information reviewed through October 30, 2026.

It is intended for professional information, education, and scientific knowledge exchange. It does not constitute a clinical practice guideline, individualized medical advice, a hepatitis B diagnostic or treatment protocol, an antiviral medication recommendation, a liver cancer surveillance protocol, or an authoritative interpretation of Vietnamese law.

Vietnam Lifestyle Medicine Alliance (VLMA) is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. VLMA is not a licensed medical examination or treatment facility, hepatitis B treatment provider, liver disease service provider, medical licensing authority, or healthcare accreditation organization. It does not independently diagnose hepatitis B, prescribe or discontinue antiviral treatment, perform liver fibrosis assessment, interpret investigations for individual clinical decisions, or provide hepatocellular carcinoma surveillance.

Clinical assessment, diagnosis, prescribing, antiviral treatment, investigation of liver disease, cancer surveillance, prevention of hepatitis B reactivation, and follow-up must be undertaken by appropriately qualified and authorized healthcare professionals and facilities within their applicable scopes of practice and in accordance with relevant Vietnamese requirements.

Lifestyle-related interventions should not delay or replace necessary medical assessment, indicated antiviral treatment, monitoring, specialist evaluation, prevention of transmission, or emergency care. Normal liver enzyme results, absence of symptoms, and successful viral suppression do not independently establish that antiviral treatment or cancer surveillance can be discontinued.

International guidelines, scientific studies, and professional frameworks are cited for educational purposes. Their inclusion does not imply that they automatically have regulatory force in Viet Nam or that VLMA has formally adopted, delivered, validated, endorsed, or certified any hepatitis B management or treatment program discussed in this article.

The illustrative patient situations are hypothetical and do not describe actual VLMA clinical activities or identifiable patients.