Liver Lineup: Advances, Gaps, and What’s Next in Viral Hepatitis

In this episode of Liver Lineup: Updates and Unfiltered Insights, hosts Nancy Reau, MD, and Kimberly Brown, MD, tackle a paradox that continues to define viral hepatitis care: despite curative therapies for hepatitis C and highly effective suppression for hepatitis B, global and domestic elimination goals remain out of reach. The conversation reframes viral hepatitis not as a “finished” chapter in hepatology, but as an ongoing public health challenge shaped by missed screening, gaps in linkage to care, and uneven adoption of evidence-based interventions.

Reau and Brown begin by emphasizing that hepatitis B and C persist largely because patients are not being identified or connected to treatment. Even in well-resourced health systems, screening often falls to primary care settings where competing priorities can delay testing. Both experts highlight successful but labor-intensive models that rely on universal screening and proactive outreach, underscoring that cure is only possible when diagnosis comes first.

The discussion then shifts to prevention strategies that extend beyond antivirals. Reviewing large population-based datasets, the hosts examine data suggesting statin use is associated with reduced risks of hepatic decompensation and hepatocellular carcinoma in patients with chronic viral hepatitis. Importantly, these benefits appear independent of antiviral therapy, reinforcing the message that statins should not be withheld solely due to compensated liver disease.

Similarly, emerging data on GLP-1 receptor agonists point to improvements in liver-related outcomes, cancer risk, and cardiometabolic complications among patients with viral hepatitis and diabetes. While neither expert advocates prescribing these agents solely for cancer prevention, both agree the findings are reassuring and further support their use when clinically indicated.

A significant portion of the episode focuses on the evolving hepatitis B pipeline, particularly strategies aimed at achieving a functional cure. Reau reviews durability data for antisense oligonucleotide therapies, noting that while response rates remain modest, selected patients with low baseline surface antigen levels may benefit. Both experts stress that durability, safety, and long-term outcomes will ultimately determine the role of these agents alongside well-tolerated lifelong nucleos(t)ide therapy.

The episode concludes with a deep dive into hepatitis D, one of the most aggressive viral liver diseases. Reau and Brown discuss promising combination approaches using monoclonal antibodies and siRNA therapies that have demonstrated substantial viral suppression in clinical trials. While relapse remains common after treatment discontinuation, the data signal meaningful progress in a field with limited therapeutic options.

Across the conversation, one message is clear: viral hepatitis may no longer dominate headlines, but sustained attention, better screening, and thoughtful integration of new therapies are essential to reducing long-term liver-related morbidity and mortality.

Editors’ 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.