Unmet Needs and Long-Term Antiviral Safety in Hepatitis B Care

In "Unmet Needs and Long-Term Antiviral Safety in Hepatitis B Care," the panel explores where guideline adherence breaks down and what long-term antiviral safety data actually show.

Dr. Chung asks why chronic hepatitis B still presents significant unmet needs in 2026 and how the gap between current standard-of-care therapy and patient and clinician expectations should be characterized.

Dr. Dieterich notes that AASLD guidelines still include ALT and AST thresholds as treatment criteria, unlike Chinese, EASL, APASL, and World Health Organization guidelines, which do not require elevated liver enzymes and instead treat at essentially any detectable viral level. He adds that adherence to strict guidelines is inconsistent, particularly since the majority of U.S. hepatitis B prescriptions are written by primary care physicians. He sees a communication gap that needs to be closed with these prescribers.

Turning to functional cure, Dr. Chung asks what improved cure rates mean for HCC risk, disease progression, and the possibility of permanently stopping therapy. Dr. Dieterich compares it to suppressing HBV DNA to undetectable levels, which dramatically lowers but does not eliminate HCC risk because integrated viral DNA remains. He says clearing surface antigen similarly lowers risk further without reaching zero, since patients retain core antibody and integrated DNA, so HCC screening must continue. He notes that seroreversion can occur even after seroconversion, whether spontaneous or treatment-induced, meaning clinicians can never fully trust the virus has left. Dr. Chung adds that patients need reminding of reactivation risk before chemotherapy, high-dose immunosuppression, or biologic therapy.

The next episode in this series, "Why Hepatitis B and Hepatitis C Cures Are Fundamentally Different," features the panel contrasting hepatitis B with hepatitis C's very different cure story.