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Review
. 2025 Oct;10(10):952-962.
doi: 10.1016/S2468-1253(25)00052-4. Epub 2025 Jul 23.

Patient and public health perspectives to inform expansion of hepatitis B treatment guidelines

Chari Cohen  1 , Thomas Tu  2 , Philippa C Matthews  3 , Su Wang  4 , Jessica Hicks  5 , Manal H El-Sayed  6 , John E Tavis  7 ; International Coalition to Eliminate HBV
Affiliations
Review

Patient and public health perspectives to inform expansion of hepatitis B treatment guidelines

Chari Cohen et al. Lancet Gastroenterol Hepatol. 2025 Oct.

Abstract

Chronic hepatitis B is associated with considerable morbidity and mortality worldwide. People living with hepatitis B face physical, emotional, social, and professional impacts, reducing their quality of life. Treatment with nucleoside or nucleotide analogues reduces the risk of liver cirrhosis and liver cancer and improves quality of life. However, few people globally are offered and can access affordable and long-term antiviral treatment. Moreover, little progress has been made towards meeting WHO hepatitis B elimination targets. The global landscape has been shifting towards expanding treatment criteria, but discussion surrounding patient and community perspectives has been inadequate. We should view treatment eligibility for hepatitis B virus infection from a public health and patient-centred approach. Here, we discuss the potential benefits and risks of expansion, implementation considerations, public health questions, and data needs surrounding the expansion of treatment eligibility. We conclude that there is a strong public health and community rationale for expanding treatment eligibility for people living with chronic hepatitis B.

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Conflict of interest statement

Declaration of interests CC reports that her institution receives education and research grants from Gilead Sciences, GlaxoSmithKline (GSK), Vir Biotechnology, Dynavax Technologies, and Roche; that she serves on patient and advocacy advisory councils for GSK and Gilead Sciences (remuneration to Hepatitis B Foundation) and as co-chair of the Hep B United coalition (remunerated through salary); is on the governing boards of ICE-HBV (unpaid) and the Hepatitis B Foundation (unpaid); and is on the steering committees of HepBcommunity.org (unpaid), HBV Forum Collaborative Research (unpaid), and HepVu (unpaid). TT received a Paul & Valeria Ainsworth Fellowship for AU$480 000 for “Precision medicine approaches to prevent the impacts of chronic hepatitis B”; his institution has received research funds from Gilead Sciences for research and community development projects, Australian Centre for HIV and Hepatitis Virology Research (ACH4) project grants for $100 000 for “Building active surveillance systems to track hepatitis C virus epidemiology and antiviral resistance” and “Cyclic peptide-based assays to increase access to hepatitis B diagnosis and testing”, a Gastroenterological Society of Australia $50 000 project grant for “Curing chronic hepatitis B by targeting virus reservoirs”, a National Health and Medical Research Council $684 000 project grant for “Inhibiting host TM6SF2 to cure hepatitis B”, and a project grant from the Stephan Urban Foundation for “Blood Results Interpreter, Getting Hep-B Tests into Everyday Simple Terms (BRIGHTEST)”; serves as consultant to Excision BioTherapeutics and Kerna Ventures with fees to his institution; serves as a paid consultant to Gilead Sciences and GSK; received payment for speaking engagements from GSK, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, and the Science of HBV Cure Meeting 2024 in Singapore; received travel and accommodation funds from GSK and the Science of HBV Cure Meeting 2024 in Singapore; and serves as President of the Australian Centre for Hepatitis Virology (unpaid); founder, Director, and Secretary (unpaid) of Hep B Voices Australia; founder and Executive Director of HepBcommunity.org (unpaid); steering committee member of the Hepatitis B Forum for Collaborative Research (unpaid); research advisory group member for the Australian WHO collaborating centre (unpaid); advisory group member for the New South Wales Hepatitis B Strategy Implementation programme (unpaid); community advisory board member (remunerated) and emerging scientific and medical advisory board member for the Hepatitis B Foundation (unpaid); advisory group member for the Australian National Hepatitis B Strategy Targets Workshop (unpaid); executive committee member for the Australian Centre for HIV and Hepatitis Virology Research (unpaid); advisory group member for ICE-HBV (unpaid); and community advisory board member (remunerated) and research advisory group member (unpaid) for ASHM. PCM receives core funding from the Francis Crick Institute (CC2223) and University College London Biomedical Research Centre (London, UK) and previously received GSK funds for a PhD fellowship for a team member (outside the scope of this submitted work). SW's institution receives research funding from Gilead Sciences. SW received travel and accommodation from WHO and the Hepatitis B Foundation, and serves on the board of directors for the Hepatitis B Foundation (unpaid), the HepBcommunity.org steering committee (unpaid), the Hepatitis B Forum for Collaborative Research steering committee (unpaid), and the WHO Global Validation Advisory Committee (unpaid). JH's institution receives grants from Abbott, Cepheid, Gilead Sciences, GSK, Kedrion, and AbbVie. JET serves on the scientific and medical advisory board for the Hepatitis B Foundation (unpaid) and on the executive committee for ICE-HBV (unpaid). MHE-S declares no competing interests.

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