Which forms of hepatitis are not always curable?

Which Forms of Hepatitis Are Not Curable?

Chronic hepatitis B and chronic hepatitis D are not curable with current treatments, while hepatitis C is curable with direct-acting antivirals. 1, 2

Hepatitis B: Not Curable

Chronic hepatitis B cannot be cured with available therapies. 3 The FDA drug label for entecavir explicitly states: "Patients should be advised that treatment with entecavir will not cure HBV." 3

Treatment Goals for Hepatitis B

• The optimal endpoint is HBsAg loss (functional cure), but this is rarely achieved with current nucleos(t)ide analogue therapy 1, 4
• Current treatment goals focus on sustained viral suppression to prevent progression to cirrhosis and hepatocellular carcinoma, not cure 1, 4
• Long-term, potentially indefinite treatment is typically required with nucleos(t)ide analogues like entecavir, tenofovir disoproxil fumarate, or tenofovir alafenamide 4

Why Hepatitis B Cannot Be Cured

• HBV DNA integrates into the host genome and forms covalently closed circular DNA (cccDNA) in hepatocytes, which persists even with effective antiviral therapy 1
• Even among persons who recovered from acute hepatitis B, viral cccDNA can still be detected in the liver, explaining reactivation when these individuals become profoundly immunosuppressed 1
• A "true cure" may not be feasible because HBV DNA remains integrated into the host genome 1

Post-Treatment Risks

• Deterioration of liver disease may occur if treatment is discontinued, with exacerbations typically happening within 6 months after stopping therapy 3
• Patients require careful monitoring with regular blood tests to check liver function if treatment is stopped 3

Hepatitis D: Not Curable

Chronic hepatitis D (HDV) infection is not curable and almost always results in chronic infection when it occurs as a superinfection in HBV carriers. 1

Key Characteristics

• HDV is a satellite virus dependent on HBV for envelope protein production 1
• HDV superinfection in HBV carriers almost always results in chronic infection with both viruses 1
• A higher proportion of persons with chronic HBV/HDV coinfection develop cirrhosis, hepatic decompensation, and HCC compared to those with chronic HBV infection alone 1

Hepatitis C: Curable

Unlike hepatitis B, chronic hepatitis C is curable with direct-acting antivirals, achieving sustained virological response (SVR) which represents a true cure. 1, 2

• New diagnostics and highly effective, pangenotypic direct-acting antivirals provide opportunities to cure and eradicate chronic hepatitis C virus infection 2
• The endpoint of sustained virological response is a cure, which is clearly associated with improved clinical outcomes such as survival and reduced HCC risk 1

Hepatitis A and E: Self-Limited

• Hepatitis A and hepatitis E typically cause acute, self-limited infections that resolve spontaneously without progressing to chronic infection 5, 2
• These do not require discussion of "cure" as they do not establish chronic infection in immunocompetent hosts 5

Clinical Implications

For chronic hepatitis B patients, counseling must emphasize that:

• Treatment suppresses but does not cure the infection 3
• Lifelong monitoring is necessary even with effective viral suppression 4
• Stopping treatment without medical supervision can lead to severe hepatitis flares 3
• The risk of transmission to others through sexual contact or blood contamination persists despite treatment 3