Despite safe and effective treatments for hepatitis B virus (HBV), fewer than 3% of the world’s 256 million chronically infected people receive them.
Now, a series of new studies makes the case for expanding access to these medications—and offers hope that a functional cure may be within reach. From slowing liver damage to triggering immune defenses with next-gen RNA therapies, researchers argue it’s time to rethink how and when we treat this silent killer. “We’re closer than ever to changing the course of this disease,” said John Tavis, Ph.D., a virologist at Saint Louis University School of Medicine.
Millions At Risk, But Treatments Remain Out of Reach
In two companion articles in The Lancet Gastroenterology & Hepatology, international experts argue for widening treatment guidelines for hepatitis B. The virus causes over 3,000 deaths every day, often by stealth. People infected at birth may carry it silently for decades, until liver cancer or cirrhosis emerges. Despite this, treatment often comes too late—or not at all.
“Less than 3% of all people infected with HBV are receiving treatment,” said Tavis, a co-author on both papers. “If we get people on medication earlier, the net disease and death rate is going to be much less.”
Currently available drugs don’t cure HBV but are inexpensive, well tolerated, and effective at halting disease progression and reducing transmission. Studies suggest early intervention could reduce liver cancer incidence by two-thirds or more.
Why Are So Few People Treated?
Much of the problem stems from outdated treatment thresholds. Researchers say current criteria leave too many people waiting until serious liver damage has already occurred.
“By delaying treatment, you leave people at risk for longer than necessary,” said Tavis. “And, you allow too much damage to the liver before you start treatment.”
Beyond biology, the virus also brings emotional and social tolls. In some regions, HBV-positive individuals face stigma, job loss, or social exclusion. “Most mothers don’t know they have the infection,” Tavis added. “And the stress of learning that you passed along a deadly illness to your baby is unimaginable.”
Hope on the Horizon: RNA Drugs Aim for Functional Cure
While improving access to current therapies is urgent, another scientific front is advancing rapidly: finding a cure. In a separate Science Translational Medicine article, researchers detail how RNA interference (RNAi) drugs could be a game-changer. These medications silence viral proteins, reduce antigen levels, and reactivate the body’s immune response.
“We’re really excited about some of these RNAi’s,” said Tavis, also a lead author on that study. “They seem to have two modes of action, both suppressing the viral antigens and turning on the immune system.”
One such RNAi drug, Bepirovirsen, remains active for months after treatment ends, while also enlisting immune cells to help fight the virus. This two-pronged effect makes it a strong candidate for combination therapy.
A Three-Pronged Treatment Strategy
Researchers now envision a cocktail approach for HBV, akin to HIV or hepatitis C regimens. The ideal therapy would combine:
- Replication inhibitors to stop the virus from multiplying
- RNAi drugs to reduce viral proteins and suppress immune evasion
- Immunomodulators to boost the body’s natural defenses
“If we do those three things together, we’re eventually going to clear the virus,” said Tavis.
How Close Are We?
Encouragingly, early clinical trial results suggest that combination therapies could offer a functional cure—defined as eliminating viral DNA and the surface antigen for at least six months post-treatment.
“In clinical trials, the best combination therapies are curing around 30% after about a year to a year and a half,” Tavis explained. “That’s a lot better than the 5% standard of care will do.”
While HBV DNA can insert itself into human genes permanently, researchers hope that a functional cure will make relapse unlikely and dramatically reduce the risk of liver cancer.
A Call for Policy Change and Global Access
The takeaway from both sets of studies is clear: existing treatments are effective and underused, while new therapies are showing real promise. Expanding access now could save millions of lives while researchers race to develop the cure of tomorrow.
“These medications are good drugs that are being badly underused,” said Tavis. “We need to adjust our treatment paradigm for this illness.”
Published Studies
“Scientific and medical evidence informing expansion of hepatitis B treatment guidelines”
The Lancet Gastroenterology & Hepatology
DOI: 10.1016/S2468-1253(25)00053-6
Publication Date: July 23, 2025
“Patient and Public Health Perspectives to Inform Expansion of HBV Treatment Guidelines”
The Lancet Gastroenterology & Hepatology
“A functional cure for chronic hepatitis B infection: mechanisms and therapeutic strategies”
Science Translational Medicine
Publication Date: July 23, 2025
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