Liver Lineup: Breaking Down Barriers in Hepatitis B Management

In this new episode of Liver Lineup, hosts Nancy Reau, MD, and Kimberly Brown, MD, welcome a special guest who brings a uniquely multidimensional perspective to hepatitis B care: Su Wang, MD, MPH.

An internist specializing in hepatitis B, Medical Director of the Center for Asian Health and Viral Hepatitis Programs at Cooperman Barnabas Medical Center, and a person living with chronic hepatitis B herself, Wang bridges the worlds of clinical medicine, guideline development, and patient advocacy.

The conversation centers on a timely and increasingly complex topic: the expanding, and at times confusing, landscape of hepatitis B guidelines. From the World Health Organization to US and European liver societies, multiple guidance documents have emerged over the past few years.

Rather than viewing this proliferation as fragmentation, Wang frames it as progress. Different guidelines serve different audiences, from hepatologists in resource-rich settings to frontline primary care clinicians and providers in low- and middle-income countries.

Still, confusion persists, particularly among non-specialists. Reau and Brown highlight a critical challenge: many clinicians see hepatitis B infrequently and may feel overwhelmed by nuanced algorithms and phase-based classifications. Wang acknowledges that complexity has historically created a kind of “paternalism,” not only toward patients but toward providers, implicitly signaling that hepatitis B management belongs solely to subspecialists.

A key shift in newer guidance, the panel notes, is the embrace of shared decision-making. Importantly, this does not simply mean deferring to patient preference—it means explicitly informing patients that treatment is an option. Wang shares sobering survey data suggesting that many individuals living with hepatitis B were never told antiviral therapy existed. The group discusses how withholding that conversation, even with good intentions, limits autonomy.

The episode also explores emerging themes reshaping hepatitis B care: recognition of metabolic comorbidities as treatment modifiers, the growing appreciation of patient-reported outcomes like fatigue and anxiety, and evolving thinking around integration and long-term oncogenic risk,not just ALT-driven inflammation.

Ultimately, this discussion moves beyond guideline minutiae to a broader call to action. Hepatitis B is common, often acquired in childhood, and too prevalent to remain siloed within hepatology. Empowering primary care clinicians to screen, vaccinate, and initiate treatment, while equipping patients with accessible tools, will be essential to meeting elimination goals.

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