MaltSci 麦伴科研

Appearance

Popular Reports / hepatology

This report is written by MaltSci based on the latest literature and research findings

What are the latest treatments for hepatitis? ​

Abstract ​

Hepatitis, particularly chronic hepatitis B (HBV) and hepatitis C (HCV), poses a significant global health challenge, affecting millions and leading to severe complications such as cirrhosis and liver cancer. The World Health Organization estimates that 290 million people live with chronic HBV, resulting in approximately 900,000 deaths annually. Similarly, HCV affects over 150 million individuals worldwide. Traditional therapies, including pegylated interferon and nucleos(t)ide analogues for HBV, and a combination of pegylated interferon with ribavirin for HCV, have shown efficacy but often fall short of achieving a functional cure. Recent advances in biomedical research have introduced novel treatment modalities, including direct-acting antivirals (DAAs) for HCV, which offer higher cure rates and improved tolerability. Additionally, innovative immunotherapeutic strategies for HBV are being explored to enhance the immune response against the virus. This review provides a comprehensive overview of the latest treatments for hepatitis, highlighting current therapies, emerging options, and future directions in the field. The integration of personalized medicine, novel antiviral agents, and gene therapy approaches holds the potential to revolutionize hepatitis management. Despite these advancements, challenges such as resistance to antiviral therapy and access to treatment remain critical issues that need to be addressed to optimize patient outcomes and reduce the global burden of hepatitis.

Outline ​

This report will discuss the following questions.

  • 1 Introduction
  • 2 Overview of Hepatitis
    • 2.1 Types of Hepatitis Viruses
    • 2.2 Epidemiology and Global Impact
  • 3 Current Treatments for Hepatitis B
    • 3.1 Antiviral Medications
    • 3.2 Immunotherapy Options
  • 4 Current Treatments for Hepatitis C
    • 4.1 Direct-Acting Antivirals (DAAs)
    • 4.2 Treatment Regimens and Outcomes
  • 5 Emerging Therapies and Future Directions
    • 5.1 Novel Antiviral Agents
    • 5.2 Gene Therapy Approaches
  • 6 Challenges in Hepatitis Management
    • 6.1 Resistance to Antiviral Therapy
    • 6.2 Access to Treatment
  • 7 Conclusion

1 Introduction ​

Hepatitis, an inflammation of the liver, remains a pressing global health issue, with significant implications for public health and individual well-being. The disease can result from various etiologies, including viral infections, autoimmune conditions, and alcohol consumption. Among these, viral hepatitis is particularly concerning, with hepatitis B virus (HBV) and hepatitis C virus (HCV) being the most prevalent. According to the World Health Organization, an estimated 290 million individuals are living with chronic HBV, leading to approximately 900,000 deaths annually, primarily due to complications such as cirrhosis and hepatocellular carcinoma [1]. Similarly, HCV affects over 150 million people worldwide, causing chronic liver disease, cirrhosis, and increasing the risk of liver cancer [2]. Given the potential for severe morbidity and mortality associated with these infections, the development of effective treatment strategies is of utmost importance.

The significance of advancing hepatitis treatment cannot be overstated. While traditional therapies have focused on viral suppression, the goal of achieving a functional cure—defined as sustained loss of hepatitis surface antigen (HBsAg) in HBV and sustained virologic response (SVR) in HCV—has gained traction in recent years [3]. Current treatments, such as nucleos(t)ide analogues and pegylated interferon for HBV, and the combination of pegylated interferon with ribavirin for HCV, have shown efficacy but often require long-term administration and may not eradicate the virus completely [1][4]. This underscores the need for innovative therapeutic approaches that not only target the virus but also enhance liver function and improve overall patient outcomes.

Recent advances in biomedical research have paved the way for novel treatment modalities, including direct-acting antivirals (DAAs) for HCV and emerging immunotherapeutic strategies for HBV [3][5]. These developments hold promise for achieving higher cure rates and minimizing the burden of chronic hepatitis. Additionally, ongoing clinical trials are exploring new therapeutic agents and regimens, highlighting the dynamic landscape of hepatitis treatment [4][6]. As our understanding of the molecular mechanisms underlying these infections deepens, the potential for personalized medicine tailored to individual patient profiles becomes increasingly viable [3].

This review will provide a comprehensive overview of the latest treatments for hepatitis, organized into several key sections. We will begin with an overview of hepatitis, including the various types of hepatitis viruses and their global epidemiology. Next, we will discuss current treatments for hepatitis B, focusing on antiviral medications and immunotherapy options. Following this, we will explore the advancements in hepatitis C treatments, particularly the role of direct-acting antivirals and their treatment regimens. We will also examine emerging therapies and future directions, including novel antiviral agents and gene therapy approaches that hold potential for curative outcomes. Furthermore, we will address the challenges faced in hepatitis management, such as resistance to antiviral therapy and access to treatment. Finally, we will conclude with insights into the future of hepatitis treatment and the ongoing need for research and development in this critical area of public health.

By synthesizing current knowledge and advancements in hepatitis treatment, this report aims to equip healthcare professionals and researchers with a thorough understanding of the evolving landscape of hepatitis management, thereby fostering improved patient care and outcomes.

2 Overview of Hepatitis ​

2.1 Types of Hepatitis Viruses ​

The treatment landscape for hepatitis, particularly chronic hepatitis B (HBV) and hepatitis C (HCV), has evolved significantly in recent years, reflecting advancements in understanding viral mechanisms and the development of novel therapeutic strategies.

For chronic hepatitis B, current approved treatments include peginterferon alpha-2a and nucleos(t)ide analogues. While these therapies are effective in preventing complications associated with chronic hepatitis B, they do not provide a complete cure, defined as the clearance of covalently closed circular DNA (cccDNA) and integrated HBV DNA. Achieving a functional cure, indicated by the loss of hepatitis B surface antigen (HBsAg), remains rare. Nevertheless, ongoing research has led to new therapeutic approaches being evaluated in clinical trials, targeting various aspects of the viral lifecycle, including viral entry, cccDNA, transcription, core protein, and the release of HBsAg and HBV polymerase. Additionally, immunological strategies focusing on both the innate and adaptive immune systems, as well as therapeutic vaccination, are being explored as promising avenues for treatment (Yardeni & Ghany, 2022) [1].

In the context of hepatitis C, the standard treatment has historically involved a combination of pegylated interferon and ribavirin, achieving curative responses in a significant proportion of patients, depending on the viral genotype. However, newer direct-acting antiviral agents (DAAs) have transformed the treatment paradigm, offering higher cure rates with shorter treatment durations and fewer side effects. Despite these advancements, there remains a need for treatments that can completely eradicate the virus. Emerging therapies include novel interferons, ribavirin analogs, and other innovative agents targeting various viral enzymes and pathways. Research continues to uncover new therapeutic targets, which is essential given the substantial burden of hepatitis C globally (Ilyas & Vierling, 2011; Firpi & Nelson, 2007) [6][7].

Furthermore, the application of nanomedicine in hepatitis C treatment is being investigated, with potential strategies including gene silencing and targeted drug delivery, which may enhance the efficacy of existing therapies and pave the way for new treatment modalities (Julien & Bach, 2025) [5].

Overall, while current therapies for hepatitis B and C have made significant strides, ongoing research into novel therapeutic options and combinations holds promise for achieving functional cures and improving patient outcomes in the future.

2.2 Epidemiology and Global Impact ​

The treatment landscape for hepatitis, particularly chronic hepatitis B and C, has evolved significantly, with ongoing research leading to the development of novel therapeutic options.

For chronic hepatitis B (HBV), which affects approximately 290 million individuals globally and results in about 900,000 deaths annually due to complications such as cirrhosis and hepatocellular carcinoma, current treatments include peginterferon alpha-2a and nucleos(t)ide analogues. However, these therapies do not provide a complete cure, as they rarely achieve functional cure defined by the loss of hepatitis B surface antigen (HBsAg) or clearance of covalently closed circular DNA (cccDNA) and integrated HBV DNA. Emerging therapies are being explored, focusing on various aspects of the viral lifecycle, immunopathogenesis, and innovative drug delivery technologies. These include targeting viral entry, cccDNA, viral transcription, core protein, and the release of HBsAg and HBV polymerase. Additionally, novel immunological strategies, such as therapeutic vaccinations and approaches that target both the innate and adaptive immune systems, are under investigation [1].

In the context of chronic hepatitis C (HCV), the current standard of care involves pegylated interferon and ribavirin, which achieve cure rates of 40% to 80% depending on the genotype. However, these treatments have limitations in terms of efficacy and side effects, necessitating the development of new therapies. Recent advancements include the introduction of Direct-Acting Antivirals (DAAs), which target specific stages of the HCV lifecycle, resulting in higher cure rates and improved tolerability. Despite the success of DAAs, there remains a need for additional therapeutic strategies to address persistent challenges, such as the emergence of resistance and the inability to completely eradicate the virus in some patients [3].

Additionally, the future of hepatitis treatment may involve the integration of nanomedicine, which could enhance drug delivery and improve therapeutic outcomes. Research in this area is focusing on gene silencing technologies and the development of vaccines to provide more effective and lasting solutions for hepatitis [5].

In summary, while current treatments for hepatitis B and C are effective in managing the diseases, there is a significant push towards developing safe, effective, and finite duration curative therapies. The breadth of novel therapeutic approaches holds promise for achieving functional cures, particularly in the context of chronic hepatitis B and C, which remain substantial global health burdens.

3 Current Treatments for Hepatitis B ​

3.1 Antiviral Medications ​

Chronic hepatitis B virus (HBV) infection remains a significant global health issue, affecting approximately 290 million individuals and leading to about 900,000 deaths annually due to complications such as cirrhosis and hepatocellular carcinoma (HCC) [1]. Current antiviral treatments for chronic hepatitis B primarily include peginterferon alpha-2a and nucleos(t)ide analogues. While these treatments can effectively prevent complications associated with chronic hepatitis B, they do not offer a complete cure, which is defined as the clearance of covalently closed circular DNA (cccDNA) and integrated HBV DNA [1].

The antiviral agents currently approved for the treatment of chronic hepatitis B include pegylated interferon alfa-2a, entecavir, tenofovir, and others, with several in various stages of clinical development [8]. Nucleos(t)ide analogues (NAs) such as lamivudine, adefovir, and telbivudine have been widely used due to their good tolerance and potent antiviral activity, which results in high rates of sustained on-treatment responses [9].

However, the existing treatments are limited by side effects and the potential for the emergence of drug-resistant viral strains [10]. Recent advancements in understanding the HBV life cycle have led to the development of novel antiviral drugs aimed at inhibiting viral replication and persistence [11]. Innovative therapeutic strategies currently under investigation include targeting various stages of the HBV life cycle, such as viral entry, cccDNA, and viral transcription [1].

Emerging therapies also encompass immunomodulatory approaches that aim to restore the host's immune response against the virus [11]. For instance, therapeutic vaccination and the targeting of innate and adaptive immune systems are being pursued to enhance the immune-mediated control of HBV [1].

Despite the availability of these antiviral medications, achieving a functional cure—defined as hepatitis B surface antigen (HBsAg) loss—remains a challenge, with only a limited number of patients attaining this outcome [9]. Thus, there is a pressing need for new antiviral agents that provide more potent antiviral effects, exhibit lower toxicity, and minimize or eliminate the risk of resistance [12].

In summary, while significant progress has been made in the treatment of chronic hepatitis B with existing antiviral medications, ongoing research is crucial to develop more effective therapies that can achieve functional and complete cures for patients. The landscape of hepatitis B treatment is evolving, with promising new therapeutic options on the horizon [13].

3.2 Immunotherapy Options ​

Chronic hepatitis B virus (HBV) infection continues to be a significant global health issue, leading to severe complications such as cirrhosis and hepatocellular carcinoma. While existing therapies primarily include pegylated interferon alpha (Peg-IFN-α) and nucleos(t)ide analogues, they often do not achieve a complete cure, necessitating the exploration of new treatment modalities, particularly immunotherapy options.

Recent advancements in immunotherapy have shown promise in addressing the limitations of current antiviral treatments. These therapies aim to restore the host's immune response against HBV, which is often dysfunctional in chronic infections. Several strategies are under investigation:

  1. Therapeutic Vaccination: Efforts are being made to develop vaccines that can effectively restore HBV-specific T cell immunity. Although traditional therapeutic vaccines have had limited success, novel approaches that target both innate and adaptive immune responses are being explored. These include checkpoint inhibitors and T cell engineering, which aim to enhance the immune response against HBV [14].

  2. Immune Cell Therapy: This approach involves the use of immune cells that are engineered or stimulated to attack HBV-infected cells. Research indicates that specific immunotherapies can potentially eliminate or maintain low levels of HBV replication by enhancing the functional host antiviral response [15].

  3. Antibody-Mediated Immunotherapy: New strategies involving HBsAg-specific antibodies are being developed to suppress serum HBsAg levels, which may help restore the virus-specific immune response. For instance, the novel monoclonal antibody E6F6 has shown the ability to durably suppress HBsAg and HBV DNA levels in preclinical studies [16].

  4. Combination Therapies: The integration of immunotherapies with existing antiviral treatments is being considered to improve outcomes. The combination of immune modulatory therapies with nucleos(t)ide analogues or Peg-IFN-α may enhance the chances of achieving a functional cure, characterized by sustained loss of HBsAg and improved clinical outcomes [17].

  5. Targeting Viral Lifecycle: Novel agents are being developed to target various stages of the HBV lifecycle, including viral entry, transcription, and replication. These agents are being evaluated in clinical trials and hold potential for providing more effective treatment options [1].

Overall, while the current landscape of hepatitis B treatment remains focused on managing the infection rather than achieving a definitive cure, the ongoing research into immunotherapy and novel antiviral strategies is paving the way for potentially curative options in the future. The combination of these emerging therapies could lead to significant advancements in the management of chronic HBV infection, ultimately improving patient outcomes and reducing the disease burden.

4 Current Treatments for Hepatitis C ​

4.1 Direct-Acting Antivirals (DAAs) ​

The landscape of hepatitis C treatment has been significantly transformed by the introduction of direct-acting antivirals (DAAs), which have become the cornerstone of therapy for chronic hepatitis C virus (HCV) infection. DAAs are designed to target specific proteins involved in the HCV life cycle, leading to effective viral suppression and eradication.

Recent advancements in DAA therapies have yielded several all-oral, once-daily regimens that demonstrate high efficacy rates exceeding 95% across various patient populations. Notable among the newly approved regimens are glecaprevir/pibrentasvir and sofosbuvir/velpatasvir/voxilaprevir, both of which are pangenotypic and have the potential to address gaps in current treatment options for patients with HCV, particularly those with genotype 3 and chronic kidney disease, as well as those who have previously failed DAA therapy [18].

DAAs can be categorized based on their mechanism of action into four main classes: (i) NS3/4A protease inhibitors, (ii) NS5A inhibitors, (iii) NS5B (nucleoside-type) polymerase inhibitors, and (iv) NS5B (non-nucleoside-type) polymerase inhibitors. Each class plays a crucial role in inhibiting different stages of the viral replication process [19].

The shift from interferon-based regimens to DAA therapies has been pivotal, as DAAs offer improved safety profiles, reduced treatment durations (typically 8 to 12 weeks), and the convenience of once-daily dosing, which enhances patient adherence [20]. Furthermore, clinical trials and real-world studies have demonstrated that these therapies are effective in diverse patient groups, including those with advanced liver disease and those who have previously been treated [21].

Despite the overwhelming success of DAAs, challenges remain, particularly in managing specific patient populations. Issues such as the treatment of patients with decompensated liver disease, those with prior treatment failures, and the need for careful monitoring of drug-drug interactions (DDIs) are critical [22]. For instance, DAAs can interact with various medications, potentially leading to increased toxicity or reduced efficacy of either the DAAs or the co-administered drugs [22].

In conclusion, the latest treatments for hepatitis C, particularly through the use of DAAs, have revolutionized the management of this chronic infection. With their high efficacy, improved safety, and simplified administration, DAAs represent a significant advancement in the quest for a cure for hepatitis C, although ongoing research and clinical vigilance are necessary to optimize their use in complex patient populations.

4.2 Treatment Regimens and Outcomes ​

The treatment landscape for hepatitis C, particularly for genotype 1 (G1) hepatitis C virus, has undergone significant advancements in recent years. The focus has shifted towards developing new treatment regimens that enhance efficacy while minimizing side effects.

Recent findings indicate that the treatment of hepatitis C has rapidly evolved, particularly over the last two years, with the introduction of new interferon-containing regimens that exhibit improved tolerability. More notably, interferon-free regimens have emerged, demonstrating outstanding efficacy with response rates exceeding 90% across diverse patient populations. These regimens often utilize multidrug combinations or two-drug combinations, which can reduce treatment duration to as little as 8 to 12 weeks, thus significantly altering the outlook for patients with hepatitis C [23].

The standard of care for hepatitis C has traditionally involved pegylated interferon and ribavirin. However, newer therapies have integrated direct-acting antivirals (DAAs), which have revolutionized treatment by achieving cure rates greater than 95%. These DAAs offer shorter treatment durations and lower toxicity profiles compared to older regimens, leading to a dramatic shift away from the era dominated by pegylated interferon and ribavirin [20].

Moreover, recent reviews highlight the importance of optimizing the use of currently available treatments while developing novel agents. Although interferon has historically played a crucial role due to its unique antiviral and immunomodulatory properties, there is an ongoing exploration of novel interferons that may provide therapeutic advantages over existing formulations [24].

The therapeutic approach continues to face challenges, particularly in the complexity of available regimens which require careful consideration of prior treatment history, viral genotype, and fibrosis assessment. This sophistication underscores the necessity for improved patient education and management strategies to enhance adherence to treatment [20].

In summary, the latest treatments for hepatitis C focus on a combination of new interferon-free regimens, DAAs, and novel interferons, which collectively aim to improve cure rates and reduce treatment duration and side effects. The ongoing evolution in this field promises to significantly impact patient outcomes and decrease the overall burden of hepatitis C infection.

5 Emerging Therapies and Future Directions ​

5.1 Novel Antiviral Agents ​

The management of viral hepatitis has seen significant advancements, particularly with the emergence of novel antiviral agents targeting various stages of viral replication and immune modulation. Current therapeutic strategies are evolving to include a variety of innovative approaches aimed at improving efficacy and reducing side effects.

For hepatitis B virus (HBV) infection, recent developments focus on enhancing viral suppression and preventing liver disease progression. Current antiviral agents include nucleos(t)ide analogs such as tenofovir and entecavir, which are widely used due to their effectiveness in achieving viral suppression. Additionally, pegylated interferon is also part of the treatment regimen. Emerging therapies under investigation include capsid/core inhibitors, immune modulators, gene editing technologies, and therapeutic vaccines. These novel agents aim to not only suppress viral replication but also induce a functional cure, which is characterized by sustained virologic response after treatment cessation [25].

In the context of hepatitis C virus (HCV), the landscape of treatment has dramatically changed with the introduction of direct-acting antivirals (DAAs). These agents target specific viral proteins, such as NS3 protease and NS5B polymerase, effectively inhibiting viral replication. Current regimens often involve combinations of DAAs that can achieve high cure rates, with treatment durations significantly shortened compared to previous therapies. The focus is now on further refining these therapies to minimize side effects and improve tolerability, particularly for patients with difficult-to-treat infections [26].

The development of novel entry inhibitors and immune modulators is also a critical area of research, particularly for chronic hepatitis D virus (HDV) infection, where few effective treatments are currently available. Bulevirtide has emerged as the first drug conditionally approved in Europe for HDV-associated compensated liver disease, marking a significant step forward in the treatment of this challenging infection [27].

Furthermore, ongoing clinical trials are exploring various combinations of existing and new agents to optimize treatment regimens for both HBV and HCV. This includes investigations into therapeutic vaccines and gene silencing technologies aimed at achieving complete viral eradication [3].

In summary, the latest treatments for hepatitis are characterized by a shift towards more targeted antiviral therapies, with ongoing research focused on enhancing the efficacy and safety profiles of these agents. The future of hepatitis treatment looks promising, with a plethora of novel agents and strategies on the horizon that could potentially transform the management of these viral infections.

5.2 Gene Therapy Approaches ​

The exploration of gene therapy approaches for hepatitis treatment is gaining traction as a promising avenue to address the limitations of existing antiviral therapies. Current treatments for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections primarily focus on chemical agents and interferons, which often yield suboptimal results due to low response rates and adverse effects. This has necessitated the search for innovative strategies, particularly gene therapy, which offers a unique method to target the viral infection at the genetic level.

Gene therapy involves the introduction of genetic material into cells to combat disease. In the context of HBV, various strategies have been developed, including the use of antisense RNA and DNA, hammerhead ribozymes, and dominant negative HBV core mutants. These methods aim to inhibit viral replication by directly targeting the viral genome or its expression pathways. Additionally, advancements in gene delivery systems, such as viral vectors (adenoviral, retroviral, and poxviral) and non-viral vectors (like liposomes), have enhanced the potential for effective gene therapy against HBV. These delivery systems are designed to specifically target liver cells, thereby increasing the therapeutic efficacy while minimizing systemic side effects (Xu et al. 2003) [28].

For HCV, the application of gene silencing technologies, including antisense oligonucleotides and RNA interference, has shown promise in preclinical studies. These approaches aim to disrupt the viral life cycle by targeting the viral RNA, thereby reducing viral load and improving patient outcomes. Despite the potential benefits, significant challenges remain in translating these technologies from laboratory settings to clinical applications, primarily due to issues related to delivery efficiency and immune responses (Thompson & Patel 2009) [29].

Emerging therapies are also focusing on immunomodulation and therapeutic vaccination strategies. These methods aim to enhance the host's immune response against HBV and HCV, potentially leading to sustained viral clearance. Research is ongoing to evaluate the efficacy of these approaches in clinical settings, as they may offer a more durable solution compared to traditional antiviral therapies (Yardeni & Ghany 2022) [1].

Overall, while gene therapy approaches for hepatitis treatment are still under investigation, they represent a forward-looking strategy that could address the critical need for effective, safe, and potentially curative therapies for chronic viral hepatitis. Continued research and clinical trials will be essential to validate these innovative treatments and determine their place in the therapeutic landscape for hepatitis B and C.

6 Challenges in Hepatitis Management ​

6.1 Resistance to Antiviral Therapy ​

The management of hepatitis, particularly chronic hepatitis B (CHB) and hepatitis C (HCV), has evolved significantly, yet challenges remain, particularly concerning resistance to antiviral therapy. Current treatments for chronic hepatitis B include pegylated interferon-α and nucleos(t)ide analogs (NAs) such as entecavir and tenofovir. These agents have improved the ability to achieve viral suppression and delay disease progression. However, the emergence of drug resistance continues to be a significant clinical challenge. For instance, the use of older antiviral agents like lamivudine has been associated with the development of resistance, which predisposes patients to multidrug resistance (Yim and Hwang, 2013) [30].

In chronic hepatitis C, the introduction of direct-acting antivirals (DAAs) has revolutionized treatment, offering the potential for a comprehensive cure. Nevertheless, even with state-of-the-art DAA combination therapies, resistance and treatment failure can still occur in a small subset of patients (Colpitts and Baumert, 2016) [31]. This highlights the need for ongoing monitoring and strategies to address resistance in clinical practice.

The persistence of covalently closed circular DNA (cccDNA) in hepatitis B virus (HBV) infection presents another barrier to achieving a definitive cure, as it complicates long-term viral suppression efforts (Ertugrul et al., 2025) [32]. Recent research is focusing on novel antiviral agents, immunomodulatory therapies, and combination strategies that aim to target various steps in the HBV replication cycle to improve treatment outcomes and potentially achieve a functional cure.

Moreover, clinical studies have demonstrated that therapies with a high barrier to resistance, such as entecavir and tenofovir, are associated with lower rates of resistance compared to those with a low barrier, such as lamivudine and adefovir (Zoulim and Locarnini, 2012) [33]. The management of treatment failure necessitates precise clinical monitoring and early intervention with complementary drugs that respect their cross-resistance profiles.

Overall, while substantial progress has been made in the treatment of hepatitis B and C, the ongoing challenge of antiviral resistance necessitates a multifaceted approach that includes optimizing current therapies, exploring novel treatment targets, and ensuring vigilant monitoring of viral resistance.

6.2 Access to Treatment ​

The management of hepatitis, particularly chronic hepatitis B and C, continues to evolve with the introduction of new treatment modalities and ongoing research into emerging therapies. Hepatitis B virus (HBV) affects an estimated 290 million individuals globally, leading to approximately 900,000 deaths annually, primarily due to complications such as cirrhosis and hepatocellular carcinoma. Current treatment options for chronic hepatitis B include peginterferon alpha-2a and nucleos(t)ide analogues, which, while effective in preventing complications, do not offer a complete cure and require long-term administration. There is a pressing need for safe, effective, and finite-duration curative therapies for HBV [1].

Recent advances in the understanding of the viral lifecycle and immunopathogenesis have paved the way for novel therapeutic approaches currently under evaluation in clinical trials. These approaches include targeting viral entry, covalently closed circular DNA (cccDNA), viral transcription, core protein, and the release of hepatitis B surface antigen (HBsAg) and HBV polymerase. Additionally, innovative immunological strategies that focus on modulating both the innate and adaptive immune systems, along with therapeutic vaccination, are being pursued [1].

For hepatitis C, the landscape of treatment has also seen significant changes. The standard of care has traditionally been a combination of pegylated interferon and ribavirin, achieving cure rates between 40% to 80%, depending on the genotype. However, the limitations of these therapies, including side effects and poor tolerability, have led to the exploration of new agents and strategies. Current research focuses on a variety of therapeutic categories, including direct-acting antivirals (DAAs), immune modulation, and novel interferons, which promise to enhance the safety and efficacy of treatment [6].

The future of hepatitis C treatment may involve the application of nanomedicine, which encompasses gene silencing, targeted drug delivery, and vaccine development. While many studies have shown success in animal models, further research is necessary to translate these findings into effective human therapies [5].

Despite these advancements, access to treatment remains a critical challenge. Barriers include the high cost of new therapies, limited availability in certain regions, and the need for comprehensive screening and treatment programs. Ensuring high vaccination coverage and implementing large-scale test-and-treat programs are essential strategies for mitigating the burden of viral hepatitis on health systems [3].

In conclusion, while there have been significant strides in the development of novel therapies for hepatitis B and C, ongoing efforts are needed to address the challenges of access and affordability, as well as to continue advancing research into curative treatments.

7 Conclusion ​

The latest advancements in hepatitis treatment reflect a significant evolution in our understanding and management of chronic hepatitis B (HBV) and hepatitis C (HCV). Current antiviral therapies for HBV, such as peginterferon and nucleos(t)ide analogues, have improved patient outcomes, yet achieving a functional cure remains a challenge due to the persistence of covalently closed circular DNA (cccDNA) and the emergence of drug resistance. Ongoing research into novel antiviral agents, immunotherapy, and gene therapy approaches holds promise for more effective treatments. In the case of HCV, the introduction of direct-acting antivirals (DAAs) has transformed the treatment landscape, offering high cure rates and reduced treatment durations. However, challenges such as resistance and access to treatment continue to impede progress. Future research must focus on overcoming these barriers, enhancing the efficacy of existing therapies, and ensuring equitable access to innovative treatments worldwide. Overall, the landscape of hepatitis management is rapidly evolving, with the potential for significant improvements in patient care and outcomes on the horizon.

References ​

  • [1] David Yardeni;Marc G Ghany. Review article: hepatitis B-current and emerging therapies.. Alimentary pharmacology & therapeutics(IF=6.7). 2022. PMID:35224760. DOI: 10.1111/apt.16828.
  • [2] Markus Cornberg;Michael P Manns. New approaches and therapeutic modalities for the treatment of patients with chronic hepatitis C.. Annals of hepatology(IF=4.4). 2005. PMID:16177653. DOI: .
  • [3] Patricia Holanda Almeida;Celso E L Matielo;Lilian A Curvelo;Rodrigo A Rocco;Guilherme Felga;Bianca Della Guardia;Yuri L Boteon. Update on the management and treatment of viral hepatitis.. World journal of gastroenterology(IF=5.4). 2021. PMID:34163109. DOI: 10.3748/wjg.v27.i23.3249.
  • [4] Raffaele De Francesco;Charles M Rice. New therapies on the horizon for hepatitis C: are we close?. Clinics in liver disease(IF=4.1). 2003. PMID:12691468. DOI: 10.1016/s1089-3261(02)00069-7.
  • [5] Drue Julien;Horacio Bach. Current treatments and the future of nanomedicine in hepatitis C.. Nanomedicine (London, England)(IF=3.9). 2025. PMID:40568840. DOI: 10.1080/17435889.2025.2518912.
  • [6] Jawad A Ilyas;John M Vierling. An overview of emerging therapies for the treatment of chronic hepatitis C.. Clinics in liver disease(IF=4.1). 2011. PMID:21867934. DOI: 10.1016/j.cld.2011.05.002.
  • [7] Roberto J Firpi;David R Nelson. Current and future hepatitis C therapies.. Archives of medical research(IF=3.4). 2007. PMID:17613359. DOI: 10.1016/j.arcmed.2006.09.002.
  • [8] Jules L Dienstag. Looking to the future: new agents for chronic hepatitis B.. The American journal of gastroenterology(IF=7.6). 2006. PMID:16448448. DOI: 10.1111/j.1572-0241.2006.00377.x.
  • [9] Jörg Petersen;Alexander J Thompson;Massimo Levrero. Aiming for cure in HBV and HDV infection.. Journal of hepatology(IF=33.0). 2016. PMID:27270043. DOI: 10.1016/j.jhep.2016.05.043.
  • [10] Fabien Zoulim. Antiviral therapy of chronic hepatitis B.. Antiviral research(IF=4.0). 2006. PMID:16716414. DOI: 10.1016/j.antiviral.2006.04.003.
  • [11] Ninghan Yang;Antonio Bertoletti. Advances in therapeutics for chronic hepatitis B.. Hepatology international(IF=6.1). 2016. PMID:26363922. DOI: 10.1007/s12072-015-9661-x.
  • [12] Anna S Lok. New treatment of chronic hepatitis B.. Seminars in liver disease(IF=3.7). 2004. PMID:15192805. DOI: 10.1055/s-2004-828682.
  • [13] Yanhua Tang;Hongyan Liang;Ge Zeng;Sheng Shen;Jian Sun. Advances in new antivirals for chronic hepatitis B.. Chinese medical journal(IF=7.3). 2022. PMID:35120358. DOI: 10.1097/CM9.0000000000001994.
  • [14] Julia Lang-Meli;Christoph Neumann-Haefelin;Robert Thimme. Immunotherapy and therapeutic vaccines for chronic HBV infection.. Current opinion in virology(IF=5.1). 2021. PMID:34710645. DOI: 10.1016/j.coviro.2021.10.002.
  • [15] Antonio Bertoletti;Nina Le Bert. Immunotherapy for Chronic Hepatitis B Virus Infection.. Gut and liver(IF=3.2). 2018. PMID:29316747. DOI: 10.5009/gnl17233.
  • [16] Ying Gao;Tian-Ying Zhang;Quan Yuan;Ning-Shao Xia. Antibody-mediated immunotherapy against chronic hepatitis B virus infection.. Human vaccines & immunotherapeutics(IF=3.5). 2017. PMID:28521640. DOI: 10.1080/21645515.2017.1319021.
  • [17] Anna S Lok;Fabien Zoulim;Geoffrey Dusheiko;Marc G Ghany. Hepatitis B cure: From discovery to regulatory approval.. Hepatology (Baltimore, Md.)(IF=15.8). 2017. PMID:28762522. DOI: 10.1002/hep.29323.
  • [18] Johannes Vermehren;James S Park;Ira M Jacobson;Stefan Zeuzem. Challenges and perspectives of direct antivirals for the treatment of hepatitis C virus infection.. Journal of hepatology(IF=33.0). 2018. PMID:30006068. DOI: 10.1016/j.jhep.2018.07.002.
  • [19] Erik De Clercq. Current race in the development of DAAs (direct-acting antivirals) against HCV.. Biochemical pharmacology(IF=5.6). 2014. PMID:24735613. DOI: .
  • [20] Ara A Kardashian;Paul J Pockros. Novel emerging treatments for hepatitis C infection: a fast-moving pipeline.. Therapeutic advances in gastroenterology(IF=3.4). 2017. PMID:28203284. DOI: 10.1177/1756283X16683875.
  • [21] Guangdi Li;Erik De Clercq. Current therapy for chronic hepatitis C: The role of direct-acting antivirals.. Antiviral research(IF=4.0). 2017. PMID:28238877. DOI: 10.1016/j.antiviral.2017.02.014.
  • [22] Michael Murray. Mechanisms and Clinical Significance of Pharmacokinetic Drug Interactions Mediated by FDA and EMA-approved Hepatitis C Direct-Acting Antiviral Agents.. Clinical pharmacokinetics(IF=4.0). 2023. PMID:37731164. DOI: 10.1007/s40262-023-01302-x.
  • [23] Graham R Foster;Sampath De Silva. Hepatitis C genotype 1.. Current opinion in infectious diseases(IF=4.0). 2014. PMID:25304394. DOI: 10.1097/QCO.0000000000000112.
  • [24] Virginia Clark;David R Nelson. Novel interferons for treatment of hepatitis C virus.. Clinics in liver disease(IF=4.1). 2009. PMID:19628153. DOI: 10.1016/j.cld.2009.05.004.
  • [25] James Lee;Nishali Shah;Rahul Kukreja;Bhargav Vemulapalli;Vinod Rustgi. Therapies and Pipeline for Hepatitis B and Hepatitis D.. Clinics in liver disease(IF=4.1). 2025. PMID:41109694. DOI: 10.1016/j.cld.2025.06.002.
  • [26] Vincenza Conteduca;Domenico Sansonno;Sabino Russi;Fabio Pavone;Franco Dammacco. Therapy of chronic hepatitis C virus infection in the era of direct-acting and host-targeting antiviral agents.. The Journal of infection(IF=11.9). 2014. PMID:24012819. DOI: .
  • [27] Simona Leoni;Alberto Casabianca;Benedetta Biagioni;Ilaria Serio. Viral hepatitis: Innovations and expectations.. World journal of gastroenterology(IF=5.4). 2022. PMID:35316960. DOI: 10.3748/wjg.v28.i5.517.
  • [28] Ruian Xu;Kexia Cai;Dexian Zheng;Hong Ma;Sue Xu;Sheung-Tat Fan. Molecular therapeutics of HBV.. Current gene therapy(IF=3.3). 2003. PMID:12871021. DOI: 10.2174/1566523034578294.
  • [29] Alexander J V Thompson;Keyur Patel. Antisense inhibitors, ribozymes, and siRNAs.. Clinics in liver disease(IF=4.1). 2009. PMID:19628155. DOI: 10.1016/j.cld.2009.05.003.
  • [30] Hyung Joon Yim;Seong Gyu Hwang. Options for the management of antiviral resistance during hepatitis B therapy: reflections on battles over a decade.. Clinical and molecular hepatology(IF=16.9). 2013. PMID:24133659. DOI: 10.3350/cmh.2013.19.3.195.
  • [31] Che C Colpitts;Thomas F Baumert. Addressing the Challenges of Hepatitis C Virus Resistance and Treatment Failure.. Viruses(IF=3.5). 2016. PMID:27537906. DOI: .
  • [32] Hamza Ertugrul;Esra Ekiz;Sibel Islak Mutcali;Veysel Tahan;Ebubekir Daglilar. Chronic Hepatitis B: Current Management and Future Directions.. Diseases (Basel, Switzerland)(IF=3.0). 2025. PMID:41149045. DOI: 10.3390/diseases13100311.
  • [33] Fabien Zoulim;Stephen Locarnini. Management of treatment failure in chronic hepatitis B.. Journal of hepatology(IF=33.0). 2012. PMID:22300461. DOI: 10.1016/S0168-8278(12)60012-9.

MaltSci Intelligent Research Services ​

Search for more papers on MaltSci.com ​

Chronic Hepatitis B · Hepatitis C · Direct Acting Antivirals · Immunotherapy · Personalized Medicine

© 2025 MaltSci