Letter to the Editor: Physical functioning as a neglected determinant of antiviral adherence in chronic hepatitis B.

As global strategies shift toward expanding treatment eligibility for chronic hepatitis B, ensuring long-term adherence is critical. Block et al recently published a study in World Journal of Virology, challenging the conventional focus on economic barriers and revealing that compromised physical functioning is a significantly more potent predictor of non-adherence than financial affordability. This finding exposes a profound "clinical discordance": Patients may achieve viral suppression yet suffer from residual fatigue and functional impairment, potentially driven by immune exhaustion or metabolic comorbidities. We argue that this symptom burden serves as a functional blockade to daily persistence. Therefore, clinical care must evolve from "adherence policing" to active symptom management. Integrating patient-reported outcomes and addressing physical deficits are essential strategies to safeguard the efficacy of antiviral regimens in the elimination era.