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Science  30 Nov 2018:
Vol. 362, Issue 6418, pp. 984-987
DOI: 10.1126/science.362.6418.984

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Summary

A new push is underway cure hepatitis B virus (HBV), which chronically infects 300 million people around the world. Although a vaccine exists to prevent infection and drugs can stave off disease, the virus still kills 900,000 people each year from cirrhosis or liver cancer. The recent remarkable success with drugs that cure hepatitis C, which is unrelated but leads to the same life-threatening problems, has spurred hope that HBV, too, can be cured. A key problem is that HBV can exist in a latent form, a minichromosome known in shorthand as cccDNA, that persists even in the presence of powerful treatment. This odd virus can also cause harm in people who have no evidence of infection on standard tests. Nearly one-third of the human population lives with cccDNA of HBV, but they are said to have "resolved" the infection and suffer no harm—unless their immune systems are compromised by cancer treatments, HIV, or drugs that battle autoimmune disease. In these people, the cccDNA can lead to a sudden, raging infection that can quickly lead to liver failure and death. Several recent scientific advances have led to new drugs that target different parts of the viral life cycle, including cccDNA, and there's increasing hope that even if they cannot eliminate the virus, they'll create a "functional" cure, knocking back the virus so powerfully that people can stop treatment and let their immune systems contain the infection.