Cure Everyone and Vaccinate the Rest: The Patient Perspective on Future Hepatitis B Treatment

Catherine Freeland; Rhea Racho; Maureen Kamischke; Kate Moraras; Evangeline Wang; Chari Cohen

Disclosures

J Viral Hepat. 2021;28(11):1539-1544. 

In This Article

Abstract and Introduction

Abstract

Those living with chronic hepatitis B virus (HBV) require years, if not decades, of regular monitoring to prevent liver complications from occurring. An estimated 292 million people were living with chronic HBV globally in 2018 with approximately 2.4 million of those residing within the United States (US). This study is one of the first of its kind that aims to explore the treatment preferences for those living with chronic HBV through qualitative interviews. Participant data were collected by in-depth telephone interviews using a semi-structured discussion guide. A codebook guided the organization of data, and codes were developed by review of the literature (a priori) and through line-by-line reading of a subsample of queries. All data transcripts (N = 19) were independently double coded. Overarching themes identified from the data specific to the treatment modalities and implications of a functional HBV cure included the concern about side effects, treatment modality, frequency, duration, cost-effectiveness and overall impact on their lives. Qualitative data analysis revealed the significant impact that an HBV functional cure would have on quality of life. Benefits of a cure were described as not having a finite course of treatment, improving overall vitality, and reducing the fear and anxiety associated with lifelong infection and potential development of liver cancer. Many individuals expressed the desire for a cure for HBV, stating it would be life-changing, and a 'miracle'. As new therapies are in development, more research should examine in detail the treatment preferences of those living with HBV.

Introduction

Those living with chronic hepatitis B virus (HBV) require years, if not decades, of regular monitoring to prevent liver complications from occurring and improve HBV-related mortality.[1] An estimated 292 million people were living with chronic HBV globally in 2018 with approximately 2.4 million of those residing within the United States (US).[2–4] Left untreated, chronic HBV infection can lead to serious liver complications and premature death.

Currently, there are antiviral therapies available that can effectively manage HBV and decrease the risk of liver failure and liver cancer for those that are treatment eligible.[5,6] However, according to current treatment guidelines, only a small percentage of people with chronic HBV meet eligibility criteria for antiviral therapy. Additionally, current antiviral therapy needs to be taken for many years, and generally, those who start antiviral therapy for HBV suppression can expect to be on treatment for life.[6]

Scientists describe that a sterilizing cure is not an achievable goal in the foreseeable future due to complexities of HBV.[7] As a result, HBV clinical research is focussing on development of a 'functional cure' for chronic HBV. This is defined as a loss of hepatitis B surface antigen (HBsAg), along with sustained undetectable HBV DNA and normalization of liver-derived enzymes in the blood, with finite treatment.[8] Several possible therapies are rapidly progressing towards clinical trial. With a surge in research on new HBV therapeutics, it is important to consider those living with HBV, their current experiences on HBV treatment, treatment preferences and the implications of a possible HBV cure on their lives. Modern medicine encourages patient involvement in treatment decisions recognizing patients as experts with a unique knowledge of their own health needs, preferences for treatments and health outcomes.[9–11] Improved patient involvement is part of quality improvement from the therapeutic development stage and has been associated with improved health outcomes.[9]

Considerations for therapeutic development should be patient centred, and feedback on current treatment mechanisms and future treatment preferences should come directly from those with lived experience. This study is one of the first of its kind that aims to explore the treatment preferences for those living with chronic HBV through qualitative interviews. This research will help inform scientists and healthcare professionals who work on the development of HBV curative therapies about the needs of those directly affected by HBV. Ultimately, the knowledge gained could improve clinical trial participation and uptake of, and adherence to, future treatments.

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