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Patient Perspectives: Individualized Hepatitis B Care

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Released: October 15, 2026

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The choice people living with HBV have today really boils down to: Do I take medicine or not? With only 3 first-line oral antivirals, treatment individualization for HBV can seem impossible, but healthcare professionals should still take care to include people living with HBV in treatment decisions—think of people first and living with hepatitis B second. Read on for my perspective as the President of the Hepatitis B Foundation. 

Chari Cohen
Chari Cohen, DrPH, MPH
Individualized Hepatitis B Care

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Why Is It Important to Individualize Hepatitis B Care?
If you've heard from one person with hepatitis B, you've heard from one person with hepatitis B. No two people's experiences living with hepatitis B are the same. Like with any other chronic health condition, each person’s journey and experience with hepatitis B virus (HBV) is a little bit different.

Especially now, as we're on the cusp of having new therapies for hepatitis B, healthcare professionals need to think critically about individual patient factors to determine who needs what. New developments in HBV care are only going to reach their maximum potential if treatment can be effectively individualized.

What Are the Limitations of Current Therapy?
We currently have effective antiviral therapy for HBV that can suppress and control viral replication, thereby improving clinical outcomes and reducing the risk of cirrhosis and liver cancer. These agents can also improve quality of life by helping people feel less fearful and anxious about their future. However, although the currently available treatment is good, there are still many issues and challenges from the patient and community perspective. 

One key challenge is that HBV therapy is long term, possibly lifelong, and requires daily adherence to oral pills. For some people, daily adherence can be challenging and burdensome. Access to the antiviral itself can be a significant barrier to adherence. In many places around the world, even in the United States, it can be challenging to regularly access antivirals because of cost or insurance coverage.

The current antivirals also have both mental and physical adverse effects. Studies found that approximately 20% of people reported physical adverse effects from their medication. Of equal importance, many people felt an emotional burden associated with taking antivirals every day. Many noted that taking a pill every day was an emotional reminder of their chronic illness and a constant reminder of their anxieties about this disease.

According to the current guidelines, not everyone is eligible for treatment. Among the people who are eligible for treatment, 68% to 90% of people who are treated with high-potency oral antivirals will eventually reach undetectable HBV DNA levels, meaning that up to 32% of people experience incomplete HBV DNA suppression. In addition, oral antivirals do not eliminate the risk of HBV-associated cirrhosis and liver cancer. Overall, they reduce the risk of liver cancer by approximately 60%, which is great, but not perfect. 

Today, the choice people living with HBV have really boils down to: Do I take medicine or not? With only 3 first-line oral antivirals, there is not a lot of room for precision medicine or treatment individualization once an individual makes the decision to initiate treatment. As a community, people living with HBV need better treatments, including curative treatments, rather than the long-term therapy currently available. This is why we are so excited about new therapies in the development pipeline that demonstrated a higher rate of functional cure and others that are being explored for partial cure or sustained control. 

What Do Patients Want HCPs to Know?
I think people living with HBV want their healthcare professionals (HCPs) to treat them holistically, not just their virus and not just their liver. They want HCPs to treat the entire person, including the social, emotional, and psychological impacts of living with HBV. 

People living with HBV want to be asked their opinion. I think shared decision-making is very important in HBV management. People want to be involved in treatment decisions and have input on their treatment goals. When considering the treatment guidelines, HCPs often think of therapy goals in terms of clinical outcomes and biomarker-related outcomes. People living with HBV may have other goals that are associated with improving quality of life rather than achieving a certain biomarker threshold.

Furthermore, treatment goals may change throughout people’s lives. Young people, who are just starting to build independence, may have very different goals than people who are in their 50s or 60s and are ready to move into a different stage in life. HCPs need to remember that people living with HBV are people first and living with HBV second.

Your Thoughts
To learn more about individualizing HBV care, join me and my colleagues Mark Sulkowksi, MD, FAASLD, and Norah Terrault, MD, MPH, at our live symposium. You can join us in person in Denver or virtually.

What are you currently doing to individualize treatment for your patients living with HBV? If you don’t see people with HBV in your practice, what do you think are some practices from management of other chronic conditions that could be incorporated into HBV care? Leave a comment to join the discussion!

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