Gastroenterology and hepatology
Hepatitis B and C management with newer therapies
Choosing and monitoring entecavir, tenofovir disoproxil and tenofovir alafenamide, when nucleos(t)ides can stop, functional cure and bepirovirsen, bulevirtide for hepatitis D, DAA choice in decompensation, renal failure and retreatment, and Australia's hepatitis B and C cascade of care.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Serology, phases and who to treat are in Viral hepatitis. This note is about the drugs: choosing them, monitoring them, stopping them, and what is new.
- Hepatitis B treatment suppresses but rarely cures. Entecavir or tenofovir are lifelong for most patients. The goal of new drugs is functional cure (HBsAg loss off treatment), and the first of these, bepirovirsen, was approved in Japan in August 2026 and by the FDA in October 2026. It isn't TGA-registered.
- Hepatitis D now has a targeted drug in Australia: bulevirtide, registered by the TGA.
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Sources
- Australian consensus recommendations for the management of hepatitis B (2022)AU/NZGastroenterological Society of Australia (GESA), 2022
- B Positive: Hepatitis B for primary care providers, 4th editionAU/NZASHM, 4th edition; PBS prescribing update September 2026
- Australian recommendations for the management of hepatitis C virus infection: a consensus statement (2022)AU/NZGESA and ASHM, 2022, with 2024 paediatric companion documents
- Australia's progress towards hepatitis C elimination: annual report 2025AU/NZBurnet Institute and Kirby Institute, 2025
- AusPAR: Hepcludex (bulevirtide)AU/NZTherapeutic Goods Administration, AusPAR 2026
- EASL Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 2025;83:502-583European Association for the Study of the Liver, 2025
- EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 2017;67:370-98European Association for the Study of the Liver, 2017
- AASLD-IDSA HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis CAASLD and IDSA, 2026 web update
- Sun Y, Gao J. Bepirovirsen: the first antisense oligonucleotide approved to achieve a functional cure for chronic hepatitis B. Drug Discov Ther 2026;20(5):397-399Drug Discoveries & Therapeutics, 2026 (Japanese approval, August 2026)
- FDA approves Hibsago (bepirovirsen) for chronic hepatitis B, based on the B-Well 1 and B-Well 2 trialsHealio, October 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback