Clinical Issues™ in Chronic Liver Disease: Hot Topics in HBV, HCV, and NASH

Three chronic diseases of the liver – HCV infection, HBV infection, and NASH – are commonly managed by gastroenterologists and hepatologists. Despite the availability of safe and effective treatments for HCV, many chronically infected patients remain unscreened, undiagnosed, and untreated.1 People who inject drugs (PWID) represent a population in particular need of recognition, diagnosis, and treatment; the path to HCV elimination will never be clear without targeting PWID.2 Managing events and comorbidities in patients with HBV can be challenging and requires careful monitoring and treatment selection, particularly for those patients who are coinfected with HCV or HIV.3 Although no medical cure is available for chronic HBV infection, clinicians must remain up to date on current and emerging treatments.3,4 NASH along with its precursor NAFLD represent a growing burden that parallels the increasing prevalence of obesity and diabetes.5 The use of invasive diagnostic modalities is often not feasible, and not all noninvasive diagnostic strategies have been validated or are widely available, which can delay the diagnosis, thereby postponing implementation of necessary lifestyle modifications and treatment.6,7 Clinicians who care for patients who have NASH are further challenged by the lack of US Food and Drug Administration (FDA)-approved therapies to treat this disease.6 Despite these clinical realities, it is important that clinicians suspect and recognize NAFLD/NASH as early in its course as possible, as is true with other chronic liver diseases, to slow progression to fibrosis and cirrhosis. During this Clinical Issues™ program, expert faculty will highlight and discuss challenges posed by these 3 chronic liver diseases, including strategies to eliminate HCV, even in the PWID population; current and future treatments of HBV; and updates on the pathophysiology and diagnosis of NASH.