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Current and Future Approaches for Managing Hepatitis B and Hepatitis C

Tracey Simon, MD, MPH
Instructor of Medicine, Harvard Medical School
Assistant in Medicine, Gastroenterology
Massachusetts General Hospital
Boston, MA

In the US, viral hepatitis C is the most common cause of cirrhosis that leads to liver cancer, but worldwide, it would be viral hepatitis B as well. As we have developed treatments that are very effective, both for controlling viral hepatitis B DNA, but also for eradicating hepatitis C infections, the sort of the proportions of liver cancer that are due to these various causes have shifted over the last five to 10 years. And that is largely due to the growing prevalence of lifestyle related liver diseases.

In terms of hepatitis B, in Asia, there has been the establishment of widespread vaccination program that has decreased the incidence of hepatitis B dramatically. In terms of hepatitis B therapy for people with chronic hepatitis B infections, antiviral therapy against hepatitis B has also had great success for controlling viral replication. That, in turn, can delay or sort of halt the progression of chronic liver disease and thereby help prevent about Hepatocellular carcinoma or HCC in those patients.

In regard to hepatitis C, since about 2011, the advent of direct-acting antiviral (DAA) based therapy has been an enormous achievement for us and has a big impact on patients. We have the capacity now to eradicate 95% to 99% of chronic hepatitis C infections. Now, the rollout and the utilization of those drugs has not quite been as widespread as we would hope in the sense that hepatitis C is not eradicated worldwide. The cost has been a barrier. And in different countries, the rollout and the uptake has not been totally as widespread as we would love to see, but there is now the potential to eradicate hepatitis C around the world.

What we need now are anti-fibrotic and anti-inflammatory treatments that are effective for preventing inflammation and fibrosis in nonalcoholic fatty liver disease, and treatments that reduce the development and progression of inflammation and fibrosis in alcohol-related liver disease. This is because they now represent growing proportions of the cases of advanced liver disease that ultimately progress to liver cancer.

Liver Cancer (hepatocellular carcinoma) is a rare cancer overall, but it has been increasing over the last 30 years in the United States. It is now one of the leading causes of cancer and also of cancer related mortality, both in the US and worldwide.

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