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Abstract Details
Evidence for Benefits of Early Treatment Initiation for Chronic Hepatitis B
1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
2Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA 94063, USA.
3Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
4Division of Gastroenterology and Hepatology, Department of Internal Medicine, Department of Medical Research, Hepatitis Research Center, National Taiwan University Hospital, Taipei 100, Taiwan.
5Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 110, Taiwan.
6Gilead Sciences, Foster City, CA 94404, USA.
7Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
8Center for Disease Analysis Foundation, Lafayette, CO 80026, USA.
9Barts Liver Centre, Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK.
Abstract
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.
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