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Forbes

Exploring Unmet Needs In Chronic Hepatitis B: Understanding The Disease, Its Impact And The Potential Of Functional Cure

Chronic Hepatitis B: The Hidden Health Threat Chronic hepatitis B (CHB) is a long-term infection of the liver caused by the hepatitis B virus (HBV). While acute hepatitis B infection is often resolved by the immune system, CHB occurs when the body's defenses are unable to eliminate the virus, allowing it to persist in the blood and liver. Getty Individuals with CHB are at an increased risk of severe liver complications, including cirrhosis, liver cancer and the potential need for a liver transplant. It remains a major global health concern, affecting approximately 254 million people worldwide.1 Yet only about 13% of those1 have been diagnosed, and just 3% receive treatment.1 Each year, more than one million people with CHB die due to complications from the infection.1 In recent years many countries, including those in the Asia-Pacific (APAC) region, have made significant progress in reducing the impact of CHB through the introduction of a hepatitis B vaccine administered to babies at birth. Although this has resulted in fewer younger people being infected, the many millions of individuals who were infected with HBV before the vaccine became widely available remain at high risk of CHB.2 Worldwide, the APAC region bears the highest overall burden of HBV, accounting for more than a quarter (26%) of new infections and almost four out of every five (79%) deaths.3 The Biology Behind CHB CHB poses a unique challenge due to its ability to evade the immune system making it particularly difficult to treat. HBV embeds its DNA into the host's liver cells, allowing it to become a permanent presence, while hijacking the cell's own processes to continue replicating.4 This cunning strategy allows the virus to persist in the body, unnoticed by the immune system. Consequently, CHB is more difficult to treat than other viral infections, such as hepatitis C, which does not integrate into a host's DNA in the same way.4 The biology of HBV also complicates efforts to eradicate the virus from the body completely, making the development of effective treatments especially challenging.5 Current treatments for CHB primarily focus on suppressing the level of the virus in the body.6 Antiviral medications can reduce the viral load and help manage the infection, decreasing the risk of liver damage. However, they do not completely eliminate the virus from the body, as the integrated viral DNA remains within the liver cells.6 The Need for Innovation in CHB Melanie Paff VP, Medicine Development Leader GSK Currently CHB requires patients to adhere to a long-term treatment option to manage their condition, which poses a burden for some people.7,8,9 'Most people living with CHB require lifelong therapy with daily medication because HBV infection typically rebounds if antiviral therapy is stopped,' explains Melanie Paff VP, Medicine Development Leader HBV Program at GSK. 'Given this, there is an urgent need for innovative options that can offer lasting solutions for patients without the burden of continuous medication.' CHB also profoundly affects people's well-being and quality of life. Those with CHB often grapple with fear and anxiety about their health and the possibility that their disease will progress despite treatment.10 Furthermore, the stigma associated with CHB can lead to social withdrawal and isolation, as individuals fear judgment and discrimination from society.10 These challenges are evident in published research showing that up to one in five people with CHB worry about being denied healthcare because of their condition and almost one third (up to 30%) are concerned about facing discrimination in the workplace, which can lead to financial insecurity and loss.11 Cultural attitudes toward CHB further complicate the lives of those affected, particularly in the APAC region. In some southeast Asian communities, up to 58% of individuals with CHB thought their illness would 'bring trouble to their family', compared with 34% of uninfected people.10 This cultural perception exacerbates feelings of guilt and shame, intensifying the psychological burden faced by those with CHB. Improving Functional Cure Jane Dong, Clinical Research Physician GSK Current treatments for CHB primarily aim to suppress HBV. However, researchers are working toward improving rates of 'functional cure' which is achieved when levels of hepatitis B surface antigen (HBsAg) and HBV DNA become low enough to be undetectable in the blood and liver, eliminating the need for continuous medication.6,12 This means that the infection is being controlled by the person's own immune system.12 A functional cure does not completely eliminate HBV from the body. Rather, it provides protection against the most severe outcomes of CHB.6 People who achieve a functional cure have freedom from the burden of daily medications, can experience an improved quality of life and reduce their risk of liver cancer.6 'Achieving functional cure could allow people to live without the constraints of daily medication, empowering them to lead healthier, more independent lives,' says Jane Dong, a clinical research physician at GSK. 'Pursuing functional cure as a treatment goal, and seeking to further increase a patient's chances of achieving this important outcome, represents a promising frontier in the science of CHB. It signifies a shift toward managing the disease in a way that is long-lasting and that prioritizes patient autonomy and well-being.' The pursuit of higher functional cure rates for CHB has the potential to revolutionize care and improve the lives of millions of people worldwide who are living with this life-long condition. Continued innovation and collaboration by the scientific community provides the opportunity for progress towards that goal.