Eliminating viral hepatitis

This Review provides an overview of the global epidemiology and burden of hepatitis B virus (HBV) infection, identifying gaps in the HBV care cascade and proposing some solutions to help reach the goal of WHO to eliminate HBV as a public health threat by 2030.

In this Review, the authors consider various paths to functional cure of chronic hepatitis B (CHB) and the need to individualize therapy of this heterogeneous infection until a therapeutic avenue for all patients with CHB is available.

Currently, there is no cure for hepatitis B virus (HBV) infection, which can lead to chronic liver disease and liver cancer, and only a few biomarkers are available. This Roadmap provides an overview of HBV serum biomarkers and their challenges.

The history of hepatitis C virus (HCV) is a role model for successful basic, translational and clinical research. In this Perspective, the authors chart a timeline of breakthroughs in hepatitis C research, from discovery to cure.

The management of viral hepatitis in the setting of pregnancy requires special consideration. This Review examines each hepatitis virus individually to address the effect of pregnancy on the natural history of infection and how the viral infections influence maternal and infant outcomes, including mother-to-child transmission.

Hepatitis B virus (HBV) infection remains a global public health issue. This Review provides insights into the evolution of HBV and discusses the mechanisms by which HBV and hepatitis delta virus diversity occurs and the influence of this diversity on disease progression and treatment response.

Multiple therapeutic approaches are being developed to achieve sustained, off-treatment suppression of HBV. In this Review, the authors examine T cell and B cell responses to HBV and the potential for immunotherapies to restore or release endogenous adaptive immunity by direct or indirect approaches.

Chronic HBV infection is a serious problem; few patients achieve the ultimate goal of hepatitis B surface antigen loss. This Review integrates findings from research in HBV infection kinetics and discusses how they can aid understanding and management of HBV infection.

Direct-acting antiviral agents (DAAs) have revolutionized the management of chronic hepatitis C, but their use in acute infection is unclear. This Review outlines the epidemiology, diagnosis and management of acute HCV infection, providing insights into the use of DAAs in at-risk populations (such as people who inject drugs).

Direct-acting antiviral agents (DAAs) are highly effective treatments for HCV, but are not always accessible to people who inject drugs (PWID). Here, Grebely and colleagues outline the epidemiology of HCV in PWID, discuss current data on DAA outcomes in this population and highlight steps required to broaden access to HCV therapy with the eventual goal of HCV elimination.

Hepatitis B virus (HBV) core protein-targeting compounds are in or entering clinical development without a standardized nomenclature. We propose a naming convention for these core-targeting antiviral products to provide clarity and accelerate HBV drug development.

Only 12 high-income countries are on track to meet the World Health Organization’s goal of eliminating hepatitis C as a public health threat by 2030, and micro-elimination opportunities in high-risk populations in settings such as hospitals are often overlooked. We propose ten steps to eliminate hepatitis C in hospitals.

Hepatitis C virus (HCV) infection is common among people who are incarcerated in low- and middle-income countries. Prison policy changes towards HCV testing and treatment are pivotal for social justice and can be a crucial step for achieving HCV global elimination targets.

Vaccination is a key intervention for the elimination of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections to fulfil the WHO’s 2030 global elimination goal. Innovations in 2021 promise to curb HBV transmission by reducing mother-to-child transmission and enhancing vaccine immunogenicity in at-risk adult groups. Additionally, an HCV vaccination trial was conducted, and there were also advances in our understanding of the immunology underpinning the lack of protection against HCV reinfection.

Progress towards hepatitis B virus (HBV) elimination targets remains slow, despite efforts to support enhanced prevention, diagnosis and treatment. On the basis of insights from interventions against HIV, we argue for the wider use of antiviral therapy for HBV, highlighting the potential public health benefits in preventing liver disease and reducing transmission.

The World Health Organization’s targets for hepatitis C elimination by 2030 are ambitious, but, in 2020, global leadership demonstrated by Egypt, innovative strategies to improve linkage to treatment for marginalized populations and the broadened capacity of direct-acting antiviral therapy have been promising for enhanced global elimination efforts.

Viral hepatitis is a global public health problem. In this Viewpoint, we asked a selection of scientists and clinicians working in the viral hepatitis field to provide their opinions on progress and pitfalls towards the 2030 viral hepatitis elimination goals.

New national hepatitis C virus (HCV) screening guidance from the United States Preventive Services Task Force includes a recommendation for one-time testing for all adults aged 18 to 79 years. Implicit in the new guidance is that all people diagnosed with chronic HCV infection should be offered HCV treatment.

Late presentation to hepatitis B virus and hepatitis C virus care is common, hindering global efforts to reduce the morbidity and mortality associated with liver disease. Models of care promoting and simplifying early testing of viral hepatitis are needed if we are to eliminate viral hepatitis as a major public health threat by 2030.

HBV and HCV infections continue to be major global health problems, causing over 1 million deaths annually. Key studies this year investigated the innate and adaptive immune responses in different clinical scenarios in HBV infection, whereas others evaluated the merits of transplanting HCV-infected organs into uninfected recipients.

More than 250 million people worldwide are chronically infected with the hepatitis B virus (HBV). In this Comment, members of the International Coalition to Eliminate HBV appraise the current policy environment and the need for appropriate cure research and preparedness to complement the WHO global elimination strategy, the HBV vaccine and the well-tolerated but poorly accessed therapy.

Recurrence of hepatocellular carcinoma after resection or ablation with curative intent is common and not prevented by direct-acting antiviral agent (DAA) therapy for hepatitis C. Owing to multiple methodological inconsistencies, available studies fail to answer whether DAA therapy anticipated risk of severe tumour recurrence: a prospective randomized study might serve the purpose.

More people die from viral hepatitis than from HIV, yet the public health response is lacking. The ACHIEVE Coalition urges governments in Europe and elsewhere to improve hepatitis B and hepatitis C monitoring so that a reliable evidence base will be available to guide the drive towards disease elimination.

In April 2015, in partnership with the US Centers for Disease Control and Prevention and Gilead Sciences, the country of Georgia launched the world's first national HCV elimination programme, aiming to reduce HCV prevalence by 90% by 2020. After 2 years of progress, how can the Georgia experience inform global approaches to eliminating HCV?

In a new report, adolescents with genotype 2 or 3 HCV infection who were given sofosbuvir and ribavirin showed a near 100% sustained virologic response. This study is the beginning of a new wave of treatments for paediatric HCV infection, forming part of a global strategy to eradicate viral hepatitis.

This Poster illustrates the current epidemiology, clinical management and novel treatment targets of hepatitis B, a disease responsible for a large global burden of liver cirrhosis and cancer.