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HBV Treatment
HBV Treatment: Powerful Tools With Important Gaps Still to Fill

Released: October 14, 2025

Su Wang
Su Wang, MD, MPH, FACP
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Key Takeaways
  • Current HBV therapy is not curative, and lifelong daily medication is a significant burden for people with HBV.
  • Early treatment is important for protection of liver health, but patient values and preference should guide treatment decisions.

Treatment Is Transformative…
As both a physician and someone who has spent years working as a patient advocate within the lived experience hepatitis B virus (HBV) community, I see each day how transformative treatment can be. When patients start antivirals, their viral load often drops quickly. That means less inflammation in the liver, a lower risk of cirrhosis and liver cancer, and reduced chances of passing HBV on to others.

These medicines are simple. They consist of just 1 pill a day, and they are generally very safe, with few side effects even after years of use. Two of the 3 available drugs are generic, which means they can be accessible at low cost. For many patients, being on treatment is the first time they feel in control of their HBV.

…But It Isn’t Perfect
However, there are still limitations to how good treatment can be. The biggest is that these medications rarely lead to loss of hepatitis B surface antigen (HBsAg), or functional cure. Even when HBV DNA is fully suppressed and the liver is healthier, most people remain HBsAg positive.

For patients, this marker is not just a lab value. Rather, it defines whether they are considered “infected.” HBsAg is used for screening by healthcare professionals (HCPs), by occupational health protocols, and even for immigration and work visas in some countries. As long as HBsAg is positive, people can face stigma, discrimination, and restrictions on opportunities, no matter how healthy their liver is.

There are other gaps as well. Treatment is long term and usually indefinite. Unlike hepatitis C therapy, there is no short course of antivirals that leads to a cure for HBV. Patients may be looking at decades of daily medication, which can feel overwhelming. Insurance adds another layer of stress, with restrictive coverage, limited formularies, prior authorization headaches, or high copays. Although tenofovir resistance is extremely rare, those who used lamivudine in the past may face entecavir resistance, which can complicate treatment choices.

Hope for the Future
Even with those limitations, early treatment has real advantages. A healthier liver today means a better chance of responding to new drugs tomorrow. Many of the cure-focused therapies in development are likely to work best in patients who already have good liver health.

It is encouraging that treatment guidelines are shifting. Where once the criteria for starting therapy were narrow and complex, there is now more support for beginning treatment earlier, before serious liver damage occurs.

This is where prioritizing shared decision-making becomes critical. Too often, HCPs recommend therapy only when patients meet strict criteria, or they decide unilaterally whether treatment is “needed.”

But HCPs must take into account patients’ different values and preferences. Some patients may prefer monitoring, and if so, it is important to support that choice so they remain engaged in care. Others may be eager to act early and initiate therapy to reduce stigma, protect their families, or feel proactive about their health. If treatment is not offered, these individuals may turn to herbal products or supplements that provide false reassurance and no protection.

Current antivirals are powerful tools. They keep people living with HBV healthier and safer, and they give us hope while we wait for the next generation of treatments. But the gaps are real, and that is why we must continue to push for new therapies with broader goals, including finite courses of treatment and meaningful HBsAg loss, so patients can truly move beyond living with HBV.

Your Thoughts
How do you approach early initiation of HBV therapy with your patients? If you use shared decision-making, how do you facilitate those conversations? Leave a comment to join the discussion!

And join my colleagues Mark Sulkowski, MD, Jordan Feld, MD, and Grace Wong, MD, at an upcoming satellite symposium. They’ll highlight innovations in HBV management—focusing on emerging biomarkers and investigational therapies for chronic suppressive management and functional cure—and explore how these advances may help close current gaps in care. You can join online or in person in Washington, DC.

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