Highlights
- Discover transformative hepatitis C treatments with cure rates above 95% through direct-acting antivirals.
- Engage with tailored public health strategies to address global barriers in hepatitis treatment access.
Summary and Overview
This guide reviews hepatitis B and C management, highlighting diagnostic methods, current and emerging treatments, and global challenges. Hepatitis causes liver inflammation from viral infections, with hepatitis B and C being most common. Hepatitis C treatment has advanced with direct-acting antivirals (DAAs) achieving over 95% cure rates, while hepatitis B treatment suppresses viral replication without cure, requiring long-term management. Experimental therapies aim for functional cures. Access to treatment remains uneven globally due to costs and infrastructure, especially in low- and middle-income countries. Prevention through vaccination and early diagnosis is critical to control the epidemic.
Hepatitis Types, Diagnosis, and Screening
Hepatitis A, B, and C are common in the U.S., each with differing progression and treatment. Chronic hepatitis B is often asymptomatic but can lead to severe liver disease over time due to immune-mediated damage. Hepatitis C can be acute or chronic; about 25% clear it spontaneously, but chronic cases risk serious liver damage. Diagnosis relies on blood tests identifying specific viral markers. Screening is essential since transmission can occur without symptoms. For hepatitis A, ELISA tests detect recent infection or immunity, while hepatitis B testing guides vaccination and monitoring, especially in pregnant women.
Treatment Options
Effective treatments exist for hepatitis B and C, focusing on preventing liver damage rather than curing chronic hepatitis B.
Hepatitis C
Hepatitis C treatment evolved from interferon and ribavirin to DAAs, which are oral, shorter (8–16 weeks), and highly effective (>95% cure). Pan-genotypic regimens like sofosbuvir/velpatasvir and glecaprevir/pibrentasvir dominate current therapy. Research continues on shorter courses and novel multi-target drugs. Patient factors influence treatment choice.
Hepatitis B
Chronic hepatitis B is treated with interferon alpha and nucleoside analogues (entecavir, tenofovir variants) that suppress viral replication but don’t cure. Long-term use requires monitoring for potential kidney and bone toxicity. Treatment is personalized based on disease activity and liver damage. Clinical trials are exploring immunomodulatory agents and functional cure approaches.
Emerging Therapies
New treatments aim to improve efficacy and reduce side effects for both hepatitis C and B. For HCV, novel interferons, nucleoside analogues, and enzyme inhibitors are in development. FDA-approved combinations provide pan-genotypic coverage and treat acute and chronic infections. For HBV, antisense oligonucleotides like bepirovirsen and recombinant antibodies such as GIGA-2339 are in trials, alongside therapeutic vaccines like TherVacB targeting immune control and potential functional cure.
Accessibility and Market Challenges
Access to hepatitis treatment varies globally, with low- and middle-income countries facing significant barriers due to high drug costs, patent protections, and infrastructure limitations. Patents on key hepatitis C drugs like sofosbuvir and EPCLUSA extend into the 2030s, delaying generics and maintaining high prices. Insurance restrictions further limit treatment access, imposing financial burdens. Despite high cure rates for hepatitis C, scaling treatment to the 58 million affected remains a challenge, necessitating expanded screening, equitable access, and supportive national programs.
Mechanisms of Antiviral Drugs
Hepatitis B antivirals include interferon alpha, which modulates immune response, and nucleoside analogues that inhibit viral DNA synthesis by terminating replication. For hepatitis C, DAAs target viral enzymes like RNA polymerase and protease, leading to rapid viral clearance. Long-term nucleoside analogue use may cause kidney and bone toxicity, requiring monitoring.
Prevention and Long-Term Management
Prevention combines vaccination—particularly the hepatitis B birth dose—with antiviral therapies to reduce progression to severe liver disease. Coinfections require integrated management. Personalized treatment based on immune response is important. Chronic hepatitis B needs ongoing monitoring to prevent complications, with treatment decisions tailored individually. Chronic hepatitis C treatment depends on genotype, disease stage, and history, with comprehensive care improving outcomes.
Global Impact and Epidemiology
Hepatitis B and C affect hundreds of millions worldwide, with the highest hepatitis B burden in the Western Pacific and Africa. Despite WHO’s 2030 elimination goals, many countries lag in diagnosis and treatment access. Hepatitis C elimination is also delayed, with many high-income countries unlikely to meet targets before 2050. Enhanced screening, treatment scale-up, and public health efforts remain critical to reduce global morbidity and mortality.
The content is provided by Blake Sterling, Scopewires
