Where the Field of Viral Hepatitis Stands and Where It's Heading

The annual state-of-the-art lecture at the European Association for the Study of the Liver (EASL) Congress carries particular weight, and the 2026 edition—delivered by Heiner Wedemeyer, MD, director of the Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology at Hannover Medical School—did not disappoint. Spanning more than 4 decades of progress across hepatitis A through E, Wedemeyer wove together public health epidemiology, cutting-edge immunology, and the most recent therapeutic breakthroughs to frame a field that is, simultaneously, transforming and falling short.

“We have the very first vaccine against cancer—the HBV [hepatitis B] vaccine,” said Wedemeyer. “We can control HBV infection. We can cure HCV [hepatitis C] infection. And yet, where we are in 2026, at least 30 million individuals still get infected with the hepatitis virus, almost 300 million are infected with HBV, and more than 1.3 million deaths due to viral hepatitis occur every single year. So despite all these achievements, we have failed.”

That tension between scientific progress and real-world impact anchored nearly every section of the lecture.

The Global Elimination Gap

Wedemeyer pointed to the recently released WHO Global Hepatitis Report as a sobering benchmark. Viral HBV and HCV claimed 1.34 million lives in 2024, with more than 4900 new infections occurring every day, even as the annual number of new hepatitis B infections has dropped by 32% and HCV-related deaths have fallen by 12% globally since 2015.² The 2026 edition concluded that progress toward the 2030 elimination targets is off track, despite the availability of effective vaccines, preventive interventions, and curative treatment for HCV.

No countries have achieved the treatment target of 50% of persons with HPB receiving treatment, and only 7 countries have met the 60% diagnosis target. "It's a disaster," Wedemeyer said, noting that he and the late Michael Manns, MD—who died in August 2024—had exchanged texts about the commission's work until 2 days before Manns' death. The lecture carried a palpable sense of tribute to Manns and to Hannover colleague Helmut Bosch, MD, who also died in 2024.

On HCV, Wedemeyer was equally direct.

"We should be able to eliminate the virus by treatment,” he said. “We have the perfect therapies."

He noted that roughly 50 million of the 60 million people living with HCV have now been treated globally, an extraordinary achievement, but reinfection and access gaps in key populations mean the work is far from done. HCV incidence continues to rise in North America despite curative therapies being available, a reflection of persistent structural and social barriers.

Hepatitis B: From Suppression to Cure

Turning to HBV, Wedemeyer framed the current landscape around a shift in therapeutic ambition, from indefinite viral suppression to finite therapy and functional cure.

He highlighted the growing body of evidence supporting treatment discontinuation in selected patients. Studies combining data from European cohorts have established that hepatitis B surface antigen (HBsAg) below 1000 IU/mL in non-Asian patients (and below 100 IU/mL in Asian patients) represents a practical clinical threshold for consideration of nucleos(t)ide analogue (NA) cessation, and a recent large collaborative analysis involving more than 2000 patients showed that roughly half of patients who stopped treatment according to these criteria achieved HBsAg loss in the long term.

"This is really remarkable," Wedemeyer noted.

But the most consequential moment of the HBV section came in his discussion of bepirovirsen (GSK), the antisense oligonucleotide that became the subject of a landmark phase 3 announcement at the Congress.³

"Yesterday, most of you witnessed a real milestone in hepatitis B research," he told the audience. "For the very first time, a phase 3 trial with the end point HBsAg loss. Twenty percent of patients lost HBsAg; it's absolutely remarkable." The B-Well data, published simultaneously in the New England Journal of Medicine, represent the first phase 3 chronic hepatitis B (CHB) trial with functional cure as the primary outcome to reach that end point, establishing a new clinical benchmark for the field.

Wedemeyer also highlighted the complexity of the immune landscape in CHB, cautioning that antigen burden alone may not fully define a patient's immunological readiness for response. He cited a whole-blood immune profiling study suggesting that current HBsAg-based stratification may not adequately reflect the immunological heterogeneity of patients and that novel immune-based stratification could improve patient selection for future immunotherapy trials. T-cell receptor-based approaches, he noted with visible enthusiasm, have demonstrated the potential to cure HBV infection in preclinical settings.

"T-cells are so powerful to get rid of the virus,” said Wedemeyer. “You can inject these T-cells—not too many—and you can really cure HBV infection.”

Hepatitis D: The Devil Gets Its Drug

Wedemeyer reserved some of his most pointed commentary for hepatitis D (HDV)—a disease he described as "D for devil" given its propensity for rapid liver disease progression and the field's most recent regulatory triumph.

"I have to announce here that last Friday, bulevirtide [Hepcludex; Gilead] was finally also approved by the FDA in the United States,” said Wedemeyer.

The announcement drew a clear emotional response from the audience. Bulevirtide became the first FDA-approved treatment for chronic HDV infection on May 22, 2026, under the accelerated approval pathway, covering adults without cirrhosis or with compensated cirrhosis.⁴ The approval was based on the MYR301 week-48 combined response of HDV ribonucleic acid (RNA) suppression plus alanine aminotransferase (ALT) normalization, achieved in 48% of patients receiving bulevirtide 8.5 mg daily vs 2% with delayed treatment. Virologic suppression deepened over time, with undetectable HDV RNA increasing from 20% at week 48 to 50% at week 144.

Wedemeyer noted that real-world data from multiple countries—Romania, Italy, Greece, Spain, and others—have confirmed bulevirtide's efficacy and safety profile seen in the trial setting. He also discussed durability after stopping treatment, citing final MYR301 data suggesting that approximately 20% of patients may achieve a durable response off therapy, particularly those with undetectable HDV RNA during treatment, and that a controlled stop strategy within his consortium has shown maintenance in a proportion of patients.

"I would not recommend stopping bulevirtide in every patient, but in principle, this is possible," he said.

Final MYR301 data presented at EASL 2025 further confirmed durability: 90% of patients who achieved undetectable HDV RNA at 96 weeks remained undetectable for nearly 2 years post treatment, he noted.

The Road Ahead

Wedemeyer closed with a rapid-fire list of unmet needs and aspirations, part manifesto, part challenge to the next generation: he wants a one-shot antiviral regimen for HCV, a vaccine against HCV, personalized long-term surveillance strategies for all hepatitis viruses, access to bulevirtide for patients with advanced liver disease, and a hepatitis E (HEV) vaccine available outside of China and Pakistan, where it currently remains limited.

"Young fellows, stay in viral hepatitis," he urged. "EASL is the home of viral hepatitis. We have a lot of things to do. We should work harder to overcome the problems."

The message, optimistic about the science and unflinching about the gap between what is possible and what has been achieved, was a fitting summary of where the field stands heading into the second half of this decade.

References

1. Wedemeyer H. Advances in the management of viral hepatitis: Jean Pierre Benhamou State of the Art Lecture. Presented at: EASL Congress; May 27-30, 2026; Barcelona, Spain.
2. Global hepatitis report 2026. WHO. April 28, 2026. Accessed May 29, 2026. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hepatitis/reports/global-hepatitis-report-2026.
3. Hou JL, Lim SG, Buti M, et al. Phase 3 results of bepirovirsen treatment for chronic hepatitis B virus infection. N Engl J Med. Published online May 28, 2026. doi:10.1056/NEJMoa2515131
4. FDA approves first treatment for chronic hepatitis delta virus (HDV) infection. FDA. News release. May 22, 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-chronic-hepatitis-delta-virus-hdv-infection.