Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA 94063, USA.
Viruses. 2023 Apr 18;15(4):997. doi: 10.3390/v15040997.
Chronic hepatitis B (CHB) is the most common cause of hepatocellular carcinoma (HCC) worldwide. Antiviral treatment reduces the risk of HCC and mortality; nonetheless, globally in 2019, only 2.2% of CHB patients received treatment. Current international CHB guidelines recommend antiviral treatment only in subsets of patients with clear evidence of liver damage. This contrasts with hepatitis C or HIV where early treatment is recommended in all infected patients, regardless of end-organ damage. This narrative review aims to provide an overview of data on the early initiation of antiviral treatment and its related potential economic impact. Literature searches were performed using PubMed and abstracts from international liver congresses (2019-2021). Data on risk of disease progression and HCC and the impact of antiviral treatment in currently ineligible patients were summarized. Cost-effectiveness data on early antiviral treatment initiation were also collated. Accumulating molecular, clinical, and economic data suggest that early initiation of antiviral treatment could save many lives through HCC prevention in a highly cost-effective manner. In light of these data, we consider several alternative expanded treatment strategies that might further a simplified 'treatment as prevention' approach.
慢性乙型肝炎（CHB）是全球肝细胞癌（HCC）最常见的病因。抗病毒治疗可降低 HCC 风险和死亡率；然而，2019 年全球仅有 2.2%的 CHB 患者接受了治疗。目前国际 CHB 指南仅建议在有明确肝损伤证据的患者亚组中进行抗病毒治疗。这与丙型肝炎或艾滋病形成对比，无论终末器官是否受损，这些疾病都建议对所有受感染的患者进行早期治疗。本叙述性综述旨在概述有关早期开始抗病毒治疗及其相关潜在经济影响的数据。使用 PubMed 和国际肝脏大会（2019-2021 年）的摘要进行了文献检索。总结了疾病进展和 HCC 的风险以及目前不符合条件的患者中抗病毒治疗的影响的数据。还整理了关于早期抗病毒治疗启动的成本效益数据。越来越多的分子、临床和经济数据表明，通过 HCC 的预防，早期开始抗病毒治疗可以以非常高的成本效益方式挽救许多生命。鉴于这些数据，我们考虑了几种替代的扩大治疗策略，这些策略可能会进一步简化“治疗即预防”的方法。
