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The Surveillance, Prevention, and Treatment of Viral Hepatitis: Looking Forward to Global Elimination

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A special issue of Livers (ISSN 2673-4389).

Deadline for manuscript submissions: 28 May 2026 | Viewed by 5249

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Dr. Melanie Deutsch

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Internal Medicine and Hepatology, National and Kapodistrian, University of Athens, Athens, Greece
Interests: hepatology; liver diseases and immunology; hepatitis B; chronic liver disease

Special Issue Information

Dear Colleagues,

The Special Issue of Livers, entitled "The Surveillance, Prevention, and Treatment of Viral Hepatitis: Looking forward to Global Elimination" is scheduled to provide an in-depth exploration of the critical components necessary for diagnosing and effectively managing viral hepatitis. Moreover, it will be of great importance to include articles dealing with the global efforts and strategies aimed at preventing and eradicating viral hepatitis, which is recognized as a significant public health challenge.

Our aim is to encompass a wide range of topics, including the latest research findings on hepatitis viruses (A, B, C, D, and E), advancements in treatment options, and the implementation of effective public health policies to achieve the goal of viral hepatitis elimination.

The issue will try to highlight the importance of early diagnosis, vaccination, and access to antiviral therapies in the fight against hepatitis. Additionally, it addresses the socio-economic factors influencing hepatitis prevalence and explores innovative approaches to increase awareness and prevention efforts in vulnerable populations.

Overall, this Special Issue aims to serve as a comprehensive resource for healthcare professionals, researchers, and policymakers, providing insights into the multifaceted approach required to improve the surveillance, prevention, and treatment of viral hepatitis.

Dr. Melanie Deutsch
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Livers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

viral hepatitis surveillance systems
preventive measures (preventive strategies, vaccination programs, awareness campaigns, harm reduction initiatives aimed at reducing transmission rates, and targeted prevention efforts for at-risk populations)
diagnostic innovations: advances in diagnostic technologies and new methods for the early detection of hepatitis viruses
antiviral therapies for hepatitis B, C, and D (existing treatments and the emergence of new therapeutic options and strategies)
public health policies in addressing the viral hepatitis epidemic
challenges and barriers faced in the surveillance, prevention, and treatment of viral hepatitis (healthcare access disparities, stigma, and the need for integrated healthcare approaches)
collaborative efforts among stakeholders, including governments, healthcare providers, and community organizations, in enhancing hepatitis control
digital health solutions that aim to improve awareness, education, and access to care for hepatitis patients

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Published Papers (5 papers)

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13 pages, 377 KB

Open AccessArticle

Identification of Unrecognized Hepatitis B, C, and D Infections Through the Private Laboratory-Based RE-LINK Screening Project in Romania: A Micro-Elimination Initiative

by Liliana Gheorghe, Antoanela Curici and Speranta Iacob

Livers 2026, 6(1), 13; https://doi.org/10.3390/livers6010013 - 20 Feb 2026

Viewed by 620

Abstract

Background/Objectives: Chronic hepatitis B (HBV) and C (HCV) remain major public health challenges in Romania despite vaccination and antiviral therapy. Understanding infection patterns in different healthcare settings is essential for targeted elimination strategies. Methods: We conducted the prospective screening phase of the RE-LINK project (January–June 2025) through two nationwide private laboratory networks. Adults undergoing routine testing were screened for HBsAg and anti-HCV. HBsAg-positive samples were further analyzed for HBV DNA, HBeAg, anti-HBe, anti-HDV, and HDV RNA, while anti-HCV-positive cases were tested for HCV RNA. Risk factors were assessed using chi-square and logistic regression analyses. Results: Among 9149 individuals (66.6% women with a median age of 53 years), HBsAg prevalence was 2.9%, and anti-HCV was 1.3%, both increasing significantly with age (p < 0.001). Of all HBsAg-positive individuals, 12.5% had undetectable HBV DNA, 70.4% had low viremia (<2000 IU/mL), and 17.1% had high viral loads. Anti-HDV antibodies were detected in 2.3% of HBsAg-positive subjects, all with detectable HDV RNA (range 1250–680,000 IU/mL). Significant risk factors for HBsAg positivity were male sex, older age, urban residence, physician-indicated testing, neuropsychiatric comorbidity, family or parental hepatitis, and institutional/orphanage care, while HBV vaccination and moderate alcohol use were protective. Anti-HCV positivity correlated with older age, cardiovascular disease, elevated transaminases, transfusions, surgery, and HIV co-infection. Only 20.2% of anti-HCV-positive individuals were viremic. Conclusions: Private-laboratory screening reveals residual low-replicative HBV and declining viremic HCV, while community programs uncover HDV and advanced disease in vulnerable groups. A coordinated approach integrating private, community, and hospital-based pathways can accelerate elimination efforts and ensure that HDV is not overlooked. Full article

(This article belongs to the Special Issue The Surveillance, Prevention, and Treatment of Viral Hepatitis: Looking Forward to Global Elimination)

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15 pages, 986 KB

Open AccessArticle

Epidemiology and Clinical Outcomes in the 20-Year HepCoVe Cohort: Progress Toward Elimination of HCV Infection in North-East Italy

by Luisa Cavalletto, Elisabetta Bernardinello, Ilenia Mezzocolli, Silvia De Carlo, Mirko Schipilliti, Eleonora Bertoli and Liliana Chemello

Livers 2026, 6(1), 7; https://doi.org/10.3390/livers6010007 - 23 Jan 2026

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Abstract

Background and Objectives: The increase in rates of cirrhosis and hepatocellular carcinoma (HCC) due to HCV infection supported the implementation of screening programs for control of this infection in Italy. The HepCoVe network has collected cases with chronic hepatitis C (CHC) in the Veneto region of North-East Italy since the 2000s. This platform allowed us to (a) compare the characteristics of the HCV cohort exposed to parenteral risk before or after 1995 (introduction of mandatory HCV testing), and (b) track the changes induced by IFN-based therapy and the novel direct-acting antivirals (DAA). Methods: From January 2000 to December 2005, 2703 prospectively recruited cases with CHC were analyzed and followed up for 16.2 ± 8.4 years, by a per protocol analysis. Results: Two epidemic waves occurred; the first, related to blood transfusions and infection with the HCV-1b and 2a/2c genotypes, affecting an elderly population, and the second, spread through drug addiction, among young people and with a prevalence of HCV-1a, 3a/3b and 4c/4d. Patients treated with DAA had more advanced liver disease; despite this, they achieved the highest SVR rate, compared to those who received an IFN-based regimen (95.1% vs. 61.5%; p < 0.01). The 10-year HCC incidence rate by KM was 0.81, 3.75, and 1.26 per 100 person-years (p-y) in cases with or without SVR and in the untreated group, respectively (p < 0.001). Conclusions: The period of exposure to HCV in Italy (born from 1939 to 1989) was supported by two epidemic waves. Unknowing cases of HCV infection are disappearing, particularly those included in the first cohort, among the “boomers”. Despite the eradication of HCV in all treated cases, antiviral therapy does not completely eliminate the risk of HCC onset. Full article

(This article belongs to the Special Issue The Surveillance, Prevention, and Treatment of Viral Hepatitis: Looking Forward to Global Elimination)

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16 pages, 585 KB

Open AccessArticle

Completeness of Initial Laboratory Evaluation Impacts Chronic Hepatitis B Outcomes

by Haris Imsirovic, Jui-Hsia (Cleo) Hung, Asnake Y. Dumicho, Douglas Manuel, Derek R. MacFadden and Curtis L. Cooper

Livers 2026, 6(1), 5; https://doi.org/10.3390/livers6010005 - 20 Jan 2026

Viewed by 737

Abstract

Introduction: The health care burden of chronic hepatitis B virus (CHB) infection can be reduced by appropriate workup, treatment, and monitoring. Methods: As a primary objective, we determined whether adequate initial hepatitis B virus (HBV) laboratory workup in CHB patients is associated with improved CHB complications risk. Secondary outcomes assessed included: mortality, hospitalization, emergency department, and liver specialist visits. We conducted a retrospective cohort study from 1 January 2012 to 31 December 2018. Participants were followed from 12 months post index event until outcome occurrence, death, loss of eligibility, or 31 March 2023. Health administrative data from Ontario, Canada was utilized. The study cohort included individuals with at least one positive result of either hepatitis B surface antigen, hepatitis B e antigen, or HBV DNA viral load documented during the study window. The exposure of interest was defined as adequate laboratory workup, defined as having subsequent quantitative HBV DNA, and alanine aminotransferase testing completed within 12 months of the index event. CHB-related complications were assessed using previously validated diagnostic codes. Modified Poisson regression modelling was used to estimate relative risks. Results: The study cohort consisted of 30,794 CHB patients, with a mean age 45.7 years. The majority were male (53.5%) and within the lowest two income quintiles (50.2%). In total, 68.0% underwent adequate workup. Individuals with adequate workup were more likely to be older, male, urban based, and of the highest racialized and newcomer populations quintile. The risk for CHB complications was 1.50 (95% CI 1.36–1.65) times greater among those with adequate workup. By multivariable analysis, adequate workup was associated with a lower risk of mortality (RR 0.78; 95% CI 0.69–0.87), all-cause hospitalizations (RR 0.77; 95% CI 0.74–0.80), all-cause (RR 0.77; 95% CI 0.75–0.78), and liver-related (RR 0.67; 95% CI 0.60–0.75) ED visits. Conclusions: Adequate CHB clinical workup is associated with improved patient outcomes. Our findings advocate for the comprehensive evaluation of CHB patients using key laboratory tests to optimize clinical management and improve long-term health outcomes. We identified gaps in the workup of young adults, females, and those residing in rural settings, which should be addressed to ensure equity of HBV care. Full article

(This article belongs to the Special Issue The Surveillance, Prevention, and Treatment of Viral Hepatitis: Looking Forward to Global Elimination)

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12 pages, 519 KB

Open AccessEditor’s ChoiceArticle

Hepatitis C Virus Opportunistic Screening in South-Eastern Tuscany Residents Admitted to the University Hospital in Siena

by Cristina Stasi, Tommaso Marzotti, Filippo Nassi, Giovanna Giugliano, Sabrina Pacini, Silvia Rentini, Riccardo Accioli, Raffaele Macchiarelli, Luigi Gennari, Pietro Enea Lazzerini and Stefano Brillanti

Livers 2025, 5(3), 30; https://doi.org/10.3390/livers5030030 - 30 Jun 2025

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Abstract

Background. To meet the WHO’s viral hepatitis elimination goal by 2030, the Minister of Health (Italy) introduced free HCV screening among people born between 1969 and 1989 and those at greater risk (people in the care of the addiction services and detained). Aims. To estimate the following: (i) the prevalence of HCV in hospitalized patients born before 1969 not included in the free HCV screening, (ii) the prevalence of transaminase values outside the range, and (iii) the HBV prevalence in a subgroup of patients. Methods. Anti-HCV antibodies and transaminase values were prospectively evaluated in patients born before 1969 and admitted to the Santa Maria alle Scotte Hospital in Siena. The first screening (October 2021–July 2022) was conducted in the Internal Medicine Division (cohort 0), and the second one (May 2024–October 2024) in Internal Medicine, Gastroenterology, and Geriatric Units (cohorts 1–3), including clinical features and HBV markers in a subgroup of patients. Results. Overall, 774 subjects underwent HCV screening. In the first screening period, 1.4% (8/567) of patients were anti-HCV+, of whom 0.7% were HCV RNA+ (4/567). In the second, 3.9% of patients (8/207) were anti-HCV+ and 0.9% were viremic (2/207). Overall, HCV prevalence was 0.8%. Of 96 patients in the gastroenterology cohort, 8 patients were at risk for occult HBV infection (8.3%). Conclusions. Our study demonstrates a chronic HCV infection prevalence of 0.8% in hospitalised patients born before 1969 and a prevalence of 8.3% of people at risk for occult HBV infection in a subgroup of patients residing in South-Eastern Tuscany, confirming that an opportunistic screening can identify the unrecognized people affected by viral hepatitis. Full article

(This article belongs to the Special Issue The Surveillance, Prevention, and Treatment of Viral Hepatitis: Looking Forward to Global Elimination)

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12 pages, 2190 KB

Open AccessSystematic Review

Indeterminate-Grey Zone of HBeAg-Negative Chronic Hepatitis B Is Associated with a Higher Risk of Hepatocellular Carcinoma Compared to HBeAg-Negative Chronic Infection—A Systematic Review and Meta-Analysis

by Rodanthi Syrigou, Dimitra Tiganiti, Kyriakos Kintzoglanakis, Vasileios Lekakis and Dimitrios S Karagiannakis

Livers 2026, 6(1), 9; https://doi.org/10.3390/livers6010009 - 4 Feb 2026

Viewed by 923

Abstract

Background and Aim: The management of patients with chronic Hepatitis B Virus (HBV) HBeAg-negative infection in the indeterminate-grey zone (GZ) remains debatable. We conducted a systematic review and meta-analysis to compare these patients with those with chronic HBV HBeAg-negative infection (inactive carriers; IC/HBeAg-negative), regarding the severity of liver inflammation and fibrosis and the risk of developing hepatocellular carcinoma (HCC). Methods: A literature search was conducted to identify all published studies comparing GZ/HBeAg-negative patients with IC/HBeAg-negative patients. Data on the severity of liver inflammation and fibrosis were extracted, and pooled relative risks (RR) and 95% confidence intervals (CI) were calculated. The risk of HCC was estimated by pooled hazard ratios (HR). A random-effects meta-analysis model was performed using R v4.1.2. Results: Eleven studies were finally included. GZ/HBeAg-negative patients had significantly higher mean HBV-DNA and alanine transferase (ALT) levels, compared to their IC/HBeAg-negative counterparts (4089.9 ± 4840.5 vs. 215.9 ± 318.1 IU/mL; p = 0.0004, and 39.6 ± 26.9 IU/L and 20.1 ± 7.6 IU/L/; p < 0.0001, respectively). GZ/HBeAg-negative patients showed a trend towards a higher risk of significant liver inflammation (RR: 5.11; 95%CI: 0.68–38.33; p = 0.1), F2/F3 fibrosis (RR: 2.13; 95%CI: 0.89–5.1; p = 0.09), and cirrhosis (RR: 14.39; 95%CI: 0.5–417.08; p = 0.12), respectively, compared to IC/HBeAg-negative patients. After a median follow-up of 6.2 years, the former group demonstrated a significantly higher risk of developing HCC (HR: 4.7; 95% CI: 1.4–15.6; p < 0.0001). Conclusions: GZ/HBeAg-negative patients have a higher risk of developing HCC compared to IC/HBeAg-negative patients, which raises concerns about the potential need to initiate treatment in this patient group. Full article

(This article belongs to the Special Issue The Surveillance, Prevention, and Treatment of Viral Hepatitis: Looking Forward to Global Elimination)

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