Here’s are the key points from the article Hepatitis B Elimination in the US—Which Gaps Need to Be Closed? (JAMA Network Open, November 2025).
✅ What the article is about
- The article is a commentary on a recent study (by Robert J. Wong et al.) that examined gaps in treatment of chronic Hepatitis B (HBV) in the U.S. — particularly in the context of national elimination goals.
- The authors argue that despite progress, HBV remains “an important yet under-addressed public health issue” in the U.S. because many people with chronic HBV are not receiving indicated antiviral therapy.
📊 Observations
- The authors note that there are an estimated 0.5 to 2.5 million people with chronic HBV in the United States — roughly 0.5% to 0.7% of the U.S. population.
- Untreated chronic HBV carries a substantial risk: about 25% of people with chronic HBV may progress to severe liver complications (e.g., cirrhosis, liver cancer, liver failure) over time.
- The referenced study of patients with documented HBV DNA (i.e., evidence of active infection) found that around 75% were not prescribed antiviral therapy, even when treatment would have been indicated under standard guidelines.
- Particularly concerning: among patients with diagnosis codes consistent with cirrhosis or liver decompensation (i.e., higher-risk patients), ≈ 40% still had no evidence of antiviral treatment.
- In the subgroup of women of childbearing potential (age 18–44) — a key group because of risks of mother-to-child HBV transmission — only 17.3% received treatment, with persistent disparities across racial and ethnic groups.
🎯 What’s Missing
The authors argue there are significant gaps that must be addressed to meet national or global HBV-elimination goals:
- Under-treatment is common, even among patients who meet clinical criteria (including those with cirrhosis or decompensated liver disease). That undermines efforts to prevent liver complications at the population level.
- Disparities by race/ethnicity and among women of childbearing age suggest that access to care, monitoring, and treatment initiation may not be equitable.
- There is a need to simplify and standardize treatment initiation criteria and to implement active follow-up/follow-through to antiviral therapy — particularly among high-risk groups.
- From a public-health and elimination perspective (including goals set by agencies such as World Health Organization and U.S. Department of Health and Human Services), the findings identify a “bottleneck”: diagnosis alone is not enough, unless diagnosis is followed by treatment.