Pharma 63: Viral Hepatitis Therapy - Suppressing a Silent Persistence

This episode focuses on hepatitis B and C as the pharmacology of containment and clearance. Unlike acute lytic infections, hepatitis viruses persist quietly within hepatocytes, driving chronic inflammation, fibrosis, and long-term risk. We explore the distinct therapeutic logics of HBV suppression versus HCV eradication-nucleos(t)ide analogues that restrain replication over years, and direct-acting antivirals that dismantle viral machinery over weeks. The clinical emphasis is strategy over speed: choosing endpoints, monitoring response, and anticipating relapse or resistance.Key takeaways to anchor understanding:* Persistence biology: why chronic infection changes therapeutic goals.* Divergent strategies: lifelong suppression (HBV) vs finite cure (HCV).* Targets and tactics: polymerases, proteases, NS5A, and combination design.* Monitoring meaning: viral load, serology, resistance, and liver health.* Systems view: adherence, access, public health impact, and cure as prevention. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit drmanaankarray.substack.com/subscribe