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.
Eliminating viral hepatitis
Viral hepatitis is a global public health problem, and the burden of disease is increasing. In 2016, spurred by development of effective new treatments for hepatitis C and expanding access to hepatitis B vaccination, the 194 Member States of the WHO committed to eliminating viral hepatitis as a public health threat by 2030. Here, Nature Reviews Gastroenterology & Hepatology explores areas vital to meeting this ambitious target, from basic viral research to public policy.
Reviews and Perspectives
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.
Clinical utility of HBV surface antigen quantification in HBV e antigen-negative chronic HBV infection
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.
Comments and opinions
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.