Empowering More Clinicians to Treat Hepatitis B

In this segment from Liver Lineup, hosts Kimberly Brown, MD, and Nancy Reau, MD, continue their conversation with Su Wang, MD, about one of the biggest barriers to improving hepatitis B care: the perception that the disease is simply too complicated for most clinicians to manage.

Brown notes that when hepatitis B is discussed in educational settings, many physicians quickly disengage. The complex interplay between viral load, ALT levels, and disease phases—often visualized through complicated graphs and algorithms—can make the topic feel intimidating, particularly for clinicians outside hepatology. That reaction, Wang says, is understandable. Many providers remember struggling through those concepts during training and may assume hepatitis B management is best left to specialists.

However, she emphasizes that that mindset presents a major obstacle to achieving global viral hepatitis elimination goals. She says hepatitis B is far too common to be managed exclusively by hepatologists. Many patients never reach specialty care, making screening, vaccination, and early evaluation in primary care settings essential.

To address this challenge, Wang highlights efforts to simplify guidance for frontline clinicians. One particularly practical resource, developed through primary care-focused guidance hosted by the University of Washington, distills hepatitis B management into a concise one-page reference. The tool outlines key screening tests, provides simple interpretation of serologic results, summarizes vaccination options, and identifies straightforward criteria that may indicate treatment.

Importantly, Wang says, newer guidance also reflects a shift in philosophy around treatment eligibility. Rather than emphasizing strict thresholds that exclude patients, recent guidelines increasingly acknowledge that treatment may be appropriate across a broader range of scenarios. Laboratory markers such as elevated ALT or viral load remain important, but additional factors, including fibrosis, comorbidities, pregnancy with high viral load, and risk of transmission, can also inform decisions.

Wang additionally points to survey data suggesting many people living with hepatitis B were never even told that antiviral therapy exists. Simply informing patients about available treatments, she says, is an important first step.

Editor’s note: Relevant disclosures for Reau include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for Brown include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal. Relevant disclosures for Wang include Gilead Sciences.

References

1. Ghany MG, Pan CQ, Lok AS, et al. AASLD ISDA Practice Guideline on treatment of chronic hepatitis B. Hepatology ():10.1097/HEP.0000000000001549, November 4, 2025. | DOI: 10.1097/HEP.0000000000001549

2. 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:10.1016/j.jhep.2025.03.018

3. You H, Wang F, Li T, et al. Guidelines for the Prevention and Treatment of Chronic Hepatitis B (version 2022). J Clin Transl Hepatol. 2023;11(6):1425-1442. doi:10.14218/JCTH.2023.00320