Recent Advances in the Diagnosis and Management of Viral Hepatitis

Abstract

Viral hepatitis, caused by hepatitis A, B, C, D and E viruses, remains one of the leading causes of chronic liver disease, cirrhosis and hepatocellular carcinoma worldwide, with hepatitis B and C viruses together responsible for the overwhelming majority of hepatitis-related mortality. Over the past few years, the field has moved rapidly on three fronts: diagnosis, drug discovery and vaccination. Point-of-care nucleic acid and antigen assays have shortened the gap between testing and treatment, while quantitative biomarkers such as HBV RNA and hepatitis B core-related antigen are being explored as tools to guide therapy and predict outcomes. Direct-acting antivirals have transformed hepatitis C into a curable infection, and the first targeted therapy for hepatitis D, the entry inhibitor bulevirtide, has moved from conditional approval to full regulatory approval in multiple regions. For hepatitis B, novel classes of agents including small interfering RNA therapeutics, capsid assembly modulators and immune-modulatory approaches are advancing through clinical trials in pursuit of a functional cure, defined as sustained loss of hepatitis B surface antigen. Vaccine science continues to evolve alongside these therapeutic advances, with high global coverage of the conventional hepatitis B vaccine, ongoing development of messenger RNA-based prophylactic and therapeutic hepatitis B vaccines, and progress toward wider licensure of the only approved hepatitis E vaccine. This review summarises recent advances in the diagnosis and management of viral hepatitis, with particular emphasis on drug discovery and vaccine development, and outlines the challenges that remain on the path to the World Health Organization's 2030 hepatitis elimination targets.