Chronic hepatitis B can be a severe, long-term disease

Progression of chronic hepatitis B

The course of chronic hepatitis B is nonlinear and characterized by repeated liver cell destruction and regeneration over long periods of time.1-3

Effects of chronic hepatitis B on the liver2,4

Free from inflammation, scarring, or damage

Swelling of the liver that can cause scarring over time

Scarring of the liver

Severe scarring of the liver that can impair liver function

Liver cancer

20% TO 30%

of adults with chronic hepatitis B will develop complications such as cirrhosis and hepatocellular carcinoma (HCC)1

HBV infection increases the risk of HCC through direct and indirect mechanisms, which may occur at early stages of tumor development and during any phase of HBV infection6-8

  • Direct mechanisms revolve around the ability of HBV to integrate into the host's genome, leading to potentially carcinogenic chromosomal aberrations and protein expression6-8
  • Indirect mechanisms center on the ability of HBV to induce continuous, recurring liver necroinflammation, which may culminate in the development of cirrhosis6,8
  • Persons with chronic hepatitis B are at a 25- to 37-fold increased risk of HCC compared to non-infected people9

Real-world data indicate that using HBV DNA level >2000 IU/mL alone for patients without cirrhosis, and removing ALT and HBeAg treatment eligibility criteria, could impact long-term outcomes for patients with chronic hepatitis B9,10

Long-term considerations

For some patients, chronic hepatitis B is a lifelong disease that requires long-term or indefinite therapy.1,11-15

  • People with chronic hepatitis B are at risk for developing comorbidities, including diabetes, metabolic syndrome, and renal and bone conditions
    • Risk for some comorbidities increases with age

Chronic hepatitis B treatment goals

When a patient has been diagnosed with chronic hepatitis B, clinical endpoints of therapy include11,16:

  • Achieving sustained suppression of HBV replication
  • ALT normalization
  • Reducing the risk of liver damage
  • HBsAg loss
  • Confirmed loss of HBeAg and seroconversion to anti-HBe antibodies (for HBeAg-positive patients) in combination with HBV DNA <2000 IU/mL, which can serve as an intermediate treatment endpoint

ALT=alanine aminotransferase; HBe=hepatitis B e; HBeAg=hepatitis B envelope antigen, HBsAg=hepatitis B surface antigen.

a Hepatocellular carcinoma may occur in patients with chronic hepatitis B without cirrhosis.1

VEMLIDY: the latest Gilead treatment option
for chronic hep B17,18

See treatment evolution

VEMLIDY: a preferred first-line chronic
hep B treatment9,11,16,19-21

Access the guidelines’ recommendations

References: 1. World Health Organization. Guidelines for the prevention, care, and treatment of persons with chronic hepatitis B infection. Geneva, Switzerland: World Health Organization; 2015. 2. Chisari FV, Isogawa M, Wieland SF. Pathogenesis of hepatitis B virus infection. Pathol Biol (Paris). 2010;58(4):258-266. 3. Martin P, Lau DT, Nguyen MH, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: 2015 update. Clin Gastroenterol Hepatol. 2015;13(12):2071-2087.e16. 4. American Liver Foundation. Progression of Liver Disease. New York, NY: American Liver Foundation; 2016. 5. D'souza S, Lau KC, Coffin CS, Patel TR. Molecular mechanisms of viral hepatitis induced hepatocellular carcinoma. World J Gastroenterol. 2020;26(38):5759-5783. doi:10.3748/wjg.v26.i38.5759 6. Levrero M, Zucman-Rossi J. Mechanisms of HBV-induced hepatocellular carcinoma. J Hepatol. 2016;64(1 Suppl):S84-S101. doi:10.1016/j.jhep.2016.02.021 7. Lupberger J, Hildt E. Hepatitis B virus-induced oncogenesis. World J Gastroenterol. 2007;13(1):74-81. doi:10.3748/wjg.v13.i1.74 8. Di Bisceglie AM. Hepatitis B and hepatocellular carcinoma. Hepatology. 2009;49(5 Suppl):S56-S60. doi:10.1002/hep.22962 9. Dieterich D, Graham C, Wang S, et al. It is time for a simplified approach to hepatitis B elimination. Gastro Hep Adv. 2022;2(2):209-218. doi:10.1016/j.gastha.2022.10.004 10. Lim YS, Seto WK, Kurosaki M, et al. Review article: switching patients with chronic hepatitis B to tenofovir alafenamide—a review of current data. Aliment Pharmacol Ther. 2022;55(8):921-943. doi:10.1111/apt.16788 11. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2025;83(2):502-583. doi:10.1016/j.jhep.2025.03.018 12. Nguyen MH, Lim JK, Ozbay AB, et al. Advancing age and comorbidity in a US insured population-based cohort of patients with chronic hepatitis B. Hepatology. 2019;69(3):959-973. doi:10.1002/hep.30246 13. Chan TM. Hepatitis B and renal disease. Curr Hepat Rep. 2010;9(2):99-105. 14. Chen YC, Su YC, Li CY, Hung SK. 13-year nationwide cohort study of chronic kidney disease risk among treatment-naive patients with chronic hepatitis B in Taiwan. BMC Nephrol. 2015;16:110. 15. Liu A, Le A, Zhang J, et al. Increasing co-morbidities in chronic hepatitis B patients: experience in primary care and referral practices during 2000-2015. Clin Transl Gastroenterol. 2018;9(3):141. 16. Ghany MG, Pan CQ, Lok AS, et al. AASLD IDSA Practice Guideline on treatment of chronic hepatitis B. Hepatology. 2026;83(4):974-997. doi:10.1097/HEP.0000000000001549 17. VEMLIDY Prescribing Information. Foster City, CA: Gilead Sciences, Inc.; March 2024. 18. TDF (tenofovir disoproxil fumarate) Prescribing Information. Foster City, CA: Gilead Sciences, Inc.; April 2019. 19. You H, Wang F, Li T, et al. Guidelines for the prevention and treatment of chronic hepatitis B (version 2022). J Clin Transl Hepatol. 2023;11(6):1425-1442. doi:10.14218/JCTH.2023.00320 20. Tong MJ, Pan CQ, Han SB, et al. An expert consensus for the management of chronic hepatitis B in Asian Americans. Aliment Pharmacol Ther. 2018;47:1181-1200. 21. Martin P, Nguyen MH, Dieterich DT, et al. Treatment algorithm for managing chronic hepatitis B virus infection in the United States: 2021 update. Clin Gastroenterol Hepatol. 2021;S1542-3565(21)00818-1. doi:10.1016/j.cgh.2021.07.036