What Patients Want From a Functional HBV Cure

Infection with hepatitis B (HBV) can be challenging. What will patients accept in exchange for the chance of a functional care?

Untreated HBV leaves people at higher risk of liver complications, including cancer. While antiviral treatment exists, based on current guidelines only about a quarter of people with hepatitis B are eligible to take it. Those who do take it need to stay on it for years, generally for the remainder of their lives.

While scientists do not immediately foresee a sterilizing cure for HBV, which would entail a complete disappearance of the virus from the body, they’re working on developing a functional cure. This would facilitate the clearance of hepatitis B surface antigen from the body, as well as prolonged undetectable HBV DNA levels and a normalization of liver enzymes.

A team of scientists from the Hepatitis B Foundation conducted a study involving in-depth interviews with people living with hepatitis B. Patients were asked their thoughts about the possibility of a functional care, if they had any concerns about it, whether they would be likely to take it, and how it could be optimized for greatest uptake. The study included 19 subjects who completed the series of interviews. Almost 4 out of 5 (79%) were currently on HBV antiviral treatment, and nearly a third (32%) were coinfected with HIV or hepatitis C or D.

“[T]he majority of individuals were really excited about the possibility of a functional cure but were concerned when asked about side effects o[f] treatment,” Catherine Freeland, MPH, program manager of the Hepatitis B Foundation and an author of the study, told Contagion®. “A couple had previous experience with PegINF (used to treat chronic hepatitis B) and remembered the harsh side effects that had on them and did not want to experience those again. Others said they would be willing to experience the side effects if they were manageable and if the medications were successful.”

Mild nausea and fatigue were deemed acceptable by many respondents, but more severe side effects were balked at, especially if the treatment was forecast to be lengthy or if there would be no antidote available to deal with the harsh effects.

Also important to the respondents was a treatment they considered “user friendly,” as 1 put it. They wanted a 1-time shot that would be long lasting, or pills they could take at home, as patients can who are undergoing hepatitis C treatment. The subjects also expressed concerns about cost and availability, although some insisted they would do “whatever it takes” to gain access to a functional cure.

The study has some limitations, including its small size. “[W]e are reporting on 19 experiences of individuals living with hepatitis B, meaning their experiences likely are not exhaustive of all individuals living with hepatitis B,” Freeland said, adding that the scientific community needs more data to have a fuller picture of the experience of living with the disease.

Nevertheless, it’s clear that the disease takes a definite toll. “[F]rom our sample, most did not describe harsh side effects on current medication but described hepatitis B as something that causes fatigue within their daily life,” Freeland said. “Others were monitored and not in need of treatment at the time of the interview. Most describe the emotional implications and stigma associated with hepatitis B as being a significant burden.”

Another limitation of the study is the fact that most participants currently take antiviral medication for hepatitis B compared with just 1 out of 4 people with hepatitis B in general, potentially skewing the results. This large proportion of subjects on medication represents the fact that the study was done using a convenience sample, Freeland noted.

Roughly 2.4 million people in the US live with hepatitis B, although less than half are aware of it. Not all who are aware of their status have their condition monitored by a healthcare provider, and even fewer take any kind of treatment. Although relatively few people with hepatitis are eligible for therapy, the hope is that the guidelines will be expanded to allow for more patients to receive therapy, Freeland said.