Chronic Hepatitis B in the United States: Current Landscape, Unmet Needs and Future Directions

Chronic hepatitis B (CHB) infection represents a major public health challenge in the US, with substantial unmet needs related to timely diagnosis, treatment, monitoring and disease management. This narrative review explores the CHB landscape in the US, including gaps in patient care, the evolving therapeutic landscape, the clinical utility of serological biomarkers to improve outcomes and the experiences of people living with hepatitis B (PLWHB). Hepatitis B remains underdiagnosed and undertreated in the US, and current efforts are insufficient to meet the associated World Health Organization 2030 elimination targets. Latest guidelines from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America, representing a North American perspective, signify a shift towards expanded treatment eligibility criteria and shared decision-making. Nucleos(t)ide analogues (NAs) are the current standard of care in the US, but functional cure is rarely achieved with NAs alone. Novel finite therapies targeting functional cure, such as antisense oligonucleotides, small interfering RNAs, immune modulators and combination or sequential regimens, are under investigation. Because of the unpredictable, complex nature of CHB, biomarkers such as quantitative hepatitis B surface antigen offer prognostic value for treatment decisions and could help guide individualised CHB management. PLWHB experience psychological impacts and health-related concerns, including fear of transmission and hepatitis B virus-related complications. Opportunities for improvement of CHB management include increased screening and linkage to care, development of more treatments targeting functional cure, adoption of serological biomarkers to inform treatment decisions and prioritising the lived experiences and preferences of PLWHB.