Chari Cohen, DrPH, MPH, is the President of the Hepatitis B Foundation.

Chari Cohen, DrPH, MPH

Most people living with hepatitis B who were taking antiviral therapy reported high adherence, while nearly two-thirds of those not on treatment were receiving no hepatitis B care at all, according to multinational survey data presented by Chari Cohen at 

“It is not silent for the people who have it,” Cohen, president of the Hepatitis B Foundation, told 

, describing the physical and emotional toll the disease takes even in the absence of liver damage.

Quality of Life in Hepatitis B: Global Survey Insights

Is HBV Really a Silent Disease? New Patient-Reported Data Suggests Otherwise

The ongoing longitudinal study surveyed 486 adults living with hepatitis B in 42 countries. Among the 50.9% taking antivirals, 86.2% reported taking medication daily as directed, and 84.4% were confident treatment was helping. Fatigue or weakness was the most commonly reported symptom (44.0%), and more than half of participants were highly concerned about liver-related illness and death. About 1 in 4 participants rated their relationship with their physician as fair or poor.

Among participants not taking antivirals, 63.7% were not engaged in any hepatitis B care, most often citing cost, limited access to clinicians or medication, or feeling healthy. Yet 73.5% said they would be very willing to start therapy if recommended.

Of the estimated 254 million people living with chronic hepatitis B worldwide in 2022, only 13% had been diagnosed and about 3% had received antiviral therapy.

 Cohen says closing that gap will require governments to prioritize hepatitis B elimination, as many did for hepatitis C. She also hopes follow-up data will help turn adherence from a reason to delay treatment into something clinicians can actively support.

Watch the full interview to hear Cohen discuss why patient-reported outcomes have long been missing from hepatitis B care, what later time points may show, and how shared decision-making can be put into practice.

Ibrahim Y, Freeland C, Cohen C. Hepatitis B patient-reported outcomes: multinational insights on quality of life and antiviral adherence. Presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, CO.

Global Hepatitis Report 2024: Action for Access in Low- and Middle-Income Countries

. World Health Organization; 2024. Accessed November 11, 2026. 

https://www.who.int/publications/i/item/9789240091672

Videos

New survey data from 42 countries show high antiviral adherence among people with hepatitis B, but 64% of those untreated receive no hepatitis B care.

Clinical Concerns Over the ACIP Infant Hepatitis B Vaccine Decision, With Chari Cohen, DrPH, MPH

The US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) has voted 8 to 3 to overturn the universal recommendation to start hepatitis B immunization at birth.

With the decision, individual-based decision-making is recommended for parents deciding whether to give the hepatitis B vaccine, including the birth dose, to infants born to women who test negative for the virus. For infants not receiving the birth dose, ACIP suggests in its recommendation that the initial dose be administered no earlier than 2 months of age.

The votes were preceded by December 4, 2025, presentations to ACIP on the hepatitis B disease burden, vaccine safety, and comparative nation immunization policies as well as briefings from representatives of the vaccine manufacturers.

In response to these presentations, the Hepatitis B Foundation released a statement expressing disappointment and concern about discussions during the meeting, a lack of transparency, and a “specific agenda” held by Committee members.

, Chari Cohen, DrPH, MPH, president of the Hepatitis B Foundation, elaborated on some of the points made in the statement, citing a shortened public comment period, confusion regarding what date the meeting was being held, and presentations from external sources rather than the CDC.

“Throughout the day, we saw this trend where when strong scientific data were brought up, somehow it was either ignored or dismissed, and that was very concerning,” Cohen added.

She went on to describe the importance of the universal birth dose of the hepatitis B vaccine and the role it plays in protecting against mother-to-child transmission and protecting infants from accidental exposure during infancy or early childhood.

While Cohen acknowledged the importance of shared decision-making and the role it already plays in healthcare, she pointed out that risk-based implementation has not worked in the context of hepatitis B vaccination in the past. From 1982 to 1991, risk-based hepatitis B vaccination strategies were largely ineffective, with the eventual transition to universal childhood vaccination helping to curb rates of infection.

“I think that pediatricians are going to need to know how to talk to parents about this, how to accurately and clearly state the information on safety to parents and help them make a decision based on science, which isn't always easy to do,” Cohen said. “I don't envy pediatricians. It's going to be really hard to translate some of this information, especially when it's really hard to justify the decision that was made.”

Editors’ Note: Cohen reports relevant disclosures with Gilead Sciences, GlaxoSmithKline, Vir Biotechnology, Dynavax Technologies, and Roche.

Brooks A. CDC Changes Infant Hepatitis B Vaccine Recommendation. HCPLive. December 5, 2025. Accessed December 5, 2025. 

https://www.hcplive.com/view/cdc-changes-infant-hepatitis-b-vaccine-recommendation

CDC. Achievements in Public Health: Hepatitis B Vaccination --- United States, 1982--2002. 

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5125a3.htm

Cohen cites past failures with risk-based hepatitis B vaccination and voices concerns about the CDC APIC vote for individual-based decision-making.

This Year in Hepatology: New MASLD Therapies, HBV Updates, and More

2025 has marked a clear turning point in 

, bringing advances that are reshaping both the scientific landscape and everyday clinical practice. After years defined by limited therapeutic options and slow-moving pipelines, this year delivered transformative progress, from the long-awaited arrival of effective pharmacologic treatments for 

, cholestatic liver diseases, portal hypertension, and alcohol-associated liver disease.

However, the momentum extends well beyond new drugs. Emerging noninvasive diagnostics, evolving disease definitions, AI-enabled pathology, and increasingly patient-centered care models are redefining how clinicians detect, stage, and manage chronic liver disease. Together, these shifts signal a rapidly accelerating era in hepatology that is expanding treatment opportunities while reshaping clinical expectations.

To capture the breadth of this evolution, the editorial team of 

 invited 7 leading experts to weigh in on the most important advances of 2025:

, an assistant professor of medicine and director of the IHEAL Clinic at the University of North Carolina School of Medicine:

I think in the past year, the biggest news has been the increasing use of medications to treat metabolic dysfunction associated-steatotic liver disease, formerly known as fatty liver disease. The weight loss medications, the GLP-1 receptor agonists, are really changing the game for this disease process. Resmetirom is another new medication we have, and just given the sheer number of patients that we have with this disease process, now finally having medications to treat them, albeit with insurance barriers, which we're working on, but I think it's really promising to be able to at least have options for these patients. Hopefully the government and local partners can help bring the prices of these medications down and increase access, because they really are beneficial.

, chairman of the Global NASH/MASH Council and professor and chairman of Beatty Liver and Obesity Research at Inova Health System:

I think the biggest news in hepatology is the drugs that we are developing for MASH. Resmetirom, semaglutide, and probably the new drugs with FGF21s, so hopefully we'll see the results next year. There is also a lot of interest in other liver diseases, understanding the dynamic nature of what we call steatotic liver disease between MASLD, MetALD, and ALD, that this is a dynamic disease that goes back and forth. So that's an important concept to understand, and there is also some hope in terms of better treatment for viral hepatitis, especially delta hepatitis, which may not be a major issue in the United States but is a major issue in some other parts of the world. So all of these actually gave me more hope that we are going to see more and more innovation and interest in this area.

, a transplant hepatologist and assistant professor of medicine at Massachusetts General Hospital and Harvard Medical School:

There have been a few pieces of breaking news in the past year. First, I'd say the most important is steatotic liver disease, and now we finally have 2 approved medications to treat patients with MASH. We used to have no other, or very little, options, except for exercise and lifestyle modification, which is very important, but also hard to do. But now we have medications that actually have been proven to be effective in reducing steatosis and also fibrosis in those patients, so it can prevent further development of advanced liver disease.

Obviously, in addition to that, we're also trying to use a combination of pharmacotherapy and behavioral therapy so once patients lose weight, they'll continue to stay in that weight for a long period of time, and that disease can be controlled or even resolved. In addition to that, what I have noticed is that alcohol-related liver disease continues to be paid attention to. In our liver disease society, we have more researchers, we have more findings in this field, and more and more people are realizing that pharmacotherapy is something that could be utilized by us to manage patients with alcohol-related liver disease, and integrated clinics actually are more utilized across the academic medical centers to manage those patients.

The third part that I've noticed is there are more lectures and more attention that is paid to address psychosocial and structural determinants in patients with chronic liver disease, for example, stigma. This year, we have a specific session for stigma and also psychosocial structural barriers. I think we're paying more and more attention in this area, which is very important, because how patients feel about their disease is also extremely important as to how we can manage and help their disease itself.

, the head of hepatology at University Hospital Zurich:

I don’t want to break it down to one piece of biggest news. I think we have seen a lot of changes from treating underlying diseases, such as in rare cholestatic liver disease the switch to symptom burden, which is more and more addressed in many disorders, which I think is very important to our patients. They sometimes care more about improved symptoms rather than an improved laboratory parameter.

We also see great developments in the field of MASLD and also fibrotic or cirrhotic MASLD. The problem is so far, we have always relied on histology, and we see clear trends towards artificial intelligence based pathology investigations or noninvasive tests to overcome the need for biopsy on a study drug, where we, hopefully, in the future, have certain definitions that indicate this is associated with improved histology, so that we can avoid biopsy and purely rely on noninvasive parameters, whether this is an Agile 4 combined laboratory parameter or a certain elastography-based measurement needs to be shown in the end. There's a clear trend in this large disease moving away.

I think these are important messages and various other aspects a little bit, depending on whom you ask, but I think quite intriguing news we have learned here in Washington, DC.

, chief academic officer of Summit Clinical Research and director of the Steatotic Liver Program at North Shore Gastroenterology:

I think being in the field of hepatology has been very exciting in the last few years. We have new treatments that are being developed for hepatitis B to achieve functional cure, and I think this will be a great addition for these patients. We also see new therapeutics being developed to treat portal hypertension, and these patients have very advanced liver disease. They're on the cusp of decompensation, so if we can take them back into a more stable stage of their disease, that will be a very important development. We are also seeing many new therapeutics to treat cholestatic liver disease, both PSC and PBC, and we also see treatments for genetic cholestasis diseases like progressive familial intrahepatic cholestasis. There's many, many new biomarkers that are being developed and screening algorithms to increase awareness of chronic liver disease in general, so I couldn't be happier to be a hepatologist.

, a professor at the Baruch S. Blumberg Institute and president of the Hepatitis B Foundation:

We have 2 new treatment guidelines for hepatitis B. EASL came out with their hepatitis B guidelines earlier in the year, and AASLD just came out with their updated hepatitis B guidelines a few days ago. We're excited to see how those are going to be implemented. We are excited as a community to have expanded treatment guidelines, and one of the central tenets of both of those guidelines is shared decision-making. We're very, very pleased to see that medical societies are paying attention to what the patient wants and understanding that the decision to initiate treatment should be a shared one between a clinician and a patient.

, a professor of medicine at Houston Methodist Hospital and co-chairman of Summit Clinical Research’s Board of Directors 

I think there are a million biggest pieces of news this year. We can talk about that for an hour, but I think the MASH field just got another big boost. There were multiple acquisitions this year, the efruxiferm acquisition, the pegozafermin acquisition, and the efimosfermin acquisition. In addition, pemvidutide came with a primary endpoint, so now we have multiple attractive phase 3 trials. With having big sponsors, I think we'll start seeing combination therapy and more trials going on. This is probably the hottest year for the MASH field ever, and I look forward to many good years coming down.

 reports relevant disclosures with Intercept, Gilead, Boehringer Ingelheim, Ipsen, Bristol-Myers Squibb, GSK, NovoNordisk, Siemens, Madridgal, Merck, Akero and Abbott. 

 reports relevant disclosures with AbbVie, AstraZeneca, Bayer, CymaBay, Gilead, GlaxoSmithKline, Intercept, Mirum, Takeda, Ipsen, and others. 

 reports relevant disclosures with Altimmune, Madrigal Pharmaceuticals, Merck, Novo Nordisk, Rivus, Takeda, and others. 

 reports relevant disclosures with Gilead Sciences, GlaxoSmithKline, Vir Biotechnology, Dynavax Technologies, and Roche. 

 reports relevant disclosures with Gilead, GlaxoSmithKline, Madrigal, Novo Nordisk, Takeda, 89BIO, Altimmune, Boehringer Ingelheim, and others.

Younossi ZM, Zelber-Sagi S, Lazarus JV, et al. Global Consensus Recommendations for Metabolic Dysfunction-Associated Steatotic Liver Disease and Steatohepatitis. Gastroenterology. 2025;169(5):1017-1032.e2. doi:

​Bansal MB, Patton H, Morgan TR, Carr RM, Dranoff JA, Allen AM. Semaglutide therapy for metabolic dysfunction-associated steatohepatitis: November 2025 updates to AASLD Practice Guidance. Hepatology. Published online November 7, 2025. doi:

European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2025;83(2):502-583. doi:

Articles

The year 2025 has marked significant advancements in hepatology, transforming both scientific research and clinical practice. Notable progress includes the introduction of effective pharmacologic treatments for MASLD/MASH, innovations in viral hepatitis, cholestatic liver diseases, and alcohol-associated liver disease. Additionally, noninvasive diagnostics, AI-enabled pathology, and patient-centered care models are redefining chronic liver disease management. Experts highlight the importance of new medications, the dynamic nature of steatotic liver disease, and the role of psychosocial factors in patient care, signaling a rapidly evolving era in hepatology.

Recent advancements in hepatology highlight new medications for metabolic dysfunction and liver diseases, promising improved patient outcomes and treatment options.

2025 in Hepatology: New MASLD Therapies, HBV Updates, and More

High Quality-of-Life Burden Among Patients With Hepatitis Delta, with Chari Cohen, MPH

New research aids clinicians' understanding of the impact of 

 on patients’ quality of life (QoL) and emphasizes the need for broader screening, increased provider and public awareness, and the holistic integration of mental, social, and financial support into HDV care.

Chari Cohen, DrPH, MPH, a professor at the Baruch S. Blumberg Institute and president of the Hepatitis B Foundation, presented the data at the 

American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025

, and highlighted the prevalence of physical symptoms, even in patients without fibrosis or cirrhosis, and the importance of raising awareness of the psychosocial impacts of HDV to improve overall patient QoL.

Understanding of the severity of HDV continues to evolve, with the International Agency for Research on Cancer classifying the disease as carcinogenic to humans in June 2025. Since HDV can only exist in individuals infected with the hepatitis B virus (HBV), dependent on the HBV surface antigen to create its own outer protein coat, patients with HDV are inherently living with comorbidities and a greater disease burden.

Previous studies have linked the HBV/HDV coinfection to a 

higher risk of severe liver-related outcomes

, including liver decompensation, hepatocellular carcinoma, liver transplantation, and death. Patients living with these diseases are at 2-6 times higher risk of liver cancer compared to HBV monoinfection.

“For the public, I think there’s just an utter lack of awareness, and if you ask most people in the world or the US what HDV is, they just won’t know. Among clinical providers, there are definitely misconceptions, and some don’t appreciate the true burden and impact on people who live with hepatitis delta,” said Cohen in an interview with 

We’ve perpetuated this for many years, saying ‘Well, hepatitis B and HDV are silent diseases.’ That’s not really true. People living with HDV who don’t show clinical evidence of liver damage still feel the impact.”

The findings presented at AASLD were based on a Qualtrics-generated survey with questions developed from prior literature. The survey was distributed through social media, newsletters, Google ads, and website postings. Virtual, in-depth qualitative interviews were conducted with interested survey participants and analyzed via Dedoose using grounded theory to describe QoL impacts.

There were 72 survey respondents from 25 countries, between 34 and 44 years of age (31%) and between 45 and 54 years of age (27%). A majority of participants came from Pakistan, the United States, and the Philippines, while 71% of respondents were male. A total of 13 participants completed qualitative interviews, most of whom were male with an average age of 42 years; 50% were from the U.S. and Pakistan.

In the survey data, investigators found a majority of patients (70%) experienced HDV symptoms, including fatigue (69%), abdominal pain (41%), muscle or joint pain (38%), and loss of appetite (38%). On a severity scale ranging from 1-10, 27% of participants ranked their symptoms as a 7, underscoring the disease’s impact and burden. Overall, 50% had been prescribed treatment for HBV and 65% for HDV.

In the qualitative interviews, participants reported lifestyle impacts such as difficulty concentrating and concerns about stigma. Investigators also identified financial challenges, such as reduced job performance, and mental impacts, including frequent anxiety, depression, despair, and fear. Healthcare-related concerns included strained communication with providers, limited access to treatment and care, and ongoing hope for a cure.

"We need to do a better job of improving the entire care cascade for hepatitis Delta by making sure that people with hepatitis delta are diagnosed. We need to have better recommendations and access to affordable screening and testing for hepatitis delta in the US,” said Cohen. “Especially since the recommendations are risk-based screenings, which are very hard to implement, and add a level of burden for both the provider and the patient. We need to do a better job incorporating patient-reported outcomes and quality of life into the clinical care journey that a person lives through."

Editor’s Note: Cohen reports relevant disclosures from Gilead Sciences, GlaxoSmithKline, Vir Biotechnology, Dynavax Technologies, and Roche.

Chari C, Beatrix Z, Shreya K, et al. Understanding Quality of Life Impacts of Hepatitis Delta Virus. Abstract presented at: American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025; November 7-11, Washington, DC.

World Health Organization. WHO urges action on hepatitis, announcing hepatitis D as carcinogenic. Who.int. Published July 28, 2025. Accessed November 9, 2025. 

https://www.who.int/news/item/28-07-2025-who-urges-action-on-hepatitis-announcing-hepatitis-d-as-carcinogenic

Furquim d’Almeida A, Ho E, Govaerts L, et al. Severe Liver‐Related Outcomes in Patients With Hepatitis Delta: Results From a Multi‐Ethnic Multicenter Long‐Term Follow‐Up Study. 

Data presented at AASLD 2025 hepatitis delta patients experience significant physical and emotional challenges, emphasizing the need for holistic care approaches and screening beyond risk-based recommendations.