Chronic Hepatitis B : Functional Cure is here but examining the liver matters

Prof Lim Seng Gee
Jul 9
2 min read

"We have not had a treatment which has come to this level of cure."

— Prof. Lim Seng Gee National University Health System, Singapore

Functional cure significantly reduces liver complications including liver cancer.

Consequences of Chronic Hepatitis B Infection

GSK’s bepirovirsen leads to high rates of functional cure (read the full report at CNN Health)

However, the exact mechanism by which this happens is unclear.

Investigating the liver using liver biopsies is crucial to understand this and to develop even better therapeutics.

Download the New England Journal of Medicine Bepi Editorial ↓

Prof Raj Reddy: Liver biopsy is a time-honored and relatively safe method for evaluating liver diseases. While general clinical enthusiasm for the procedure has recently dwindled, it remains a cornerstone in several key areas:

Clinical Trials: It is paradoxically required by regulatory authorities for therapeutic interventions in MASLD.
Liver Transplants: It remains essential for assessing graft dysfunction in recipients.
Uncertain Diagnoses: It still plays a critical role in diagnosing conditions like autoimmune hepatitis, Wilson disease, hemochromatosis, and confusing space-occupying lesions.

Looking ahead, the evolving field of endo-hepatology may yet see a resurgence of enthusiasm for liver biopsies.

(Ref: Liver biopsy: Archaic but resilient and many roads lead to Rome, Clinical Liver Disease 2024: PMCID: PMC11216678 DOI: 10.1097/CLD.0000000000000247)

Contextual References:

AASLD guidelines on Liver Biopsy 2009: Histological assessment of the liver, and thus, liver biopsy, is a cornerstone in the evaluation and management of patients with liver disease and has long been considered to be an integral component of the clinician’s diagnostic armamentarium. Although sensitive and relatively accurate blood tests used to detect and diagnose liver disease have now become widely available, it is likely that liver biopsy will remain a valuable diagnostic tool. https://www.aasld.org/practice-guidelines/liver-biopsy

Highlights From the Recent AASLD Practice Guidelines on Noninvasive Assessment of Hepatic Fibrosis and Steatosis: The gold standard for fibrosis assessment is liver biopsy, but this is an invasive procedure that can be associated with pain, bleeding, and, rarely, puncture of other organs. ref: https://pmc.ncbi.nlm.nih.gov/articles/PMC11523086/

Is liver biopsy still useful in the era of non-invasive tests? yes: Liver biopsy has been referred to as the gold standard for the diagnosis of liver diseases and evaluation of liver fibrosis or liver damage. Ref: https://pmc.ncbi.nlm.nih.gov/articles/PMC7364357/