Risk stratification of HBV infection in Asia-Pacific region

Area of Science:

• Hepatology
• Virology
• Oncology

Background:

• Hepatitis B virus (HBV) infection is a leading cause of chronic liver disease globally, particularly in Asia.
• Outcomes for Asian HBV carriers vary, with a significant risk of end-stage liver disease and hepatocellular carcinoma (HCC).
• Identifying predictive factors for HCC in HBV carriers is crucial for risk stratification and management.

Purpose of the Study:

• To identify host and HBV factors that predict clinical outcomes, specifically HCC risk, in Asian HBV carriers.
• To validate established HCC risk factors and explore novel predictors like Hepatitis B surface antigen (HBsAg) levels.
• To develop and validate tools for predicting HCC and disease progression in chronic HBV infection.

Main Methods:

• Analysis of data from community-based (REVEAL-HBV) and hospital-based (ERADICATE-B) cohorts of Asian HBV carriers.
• Statistical analysis to identify independent predictors of HCC, including HBV-DNA levels, HBsAg levels, alanine aminotransferase (ALT), and demographic factors.
• Development and validation of risk prediction models and algorithms for HCC in non-cirrhotic patients.

Main Results:

• HBV-DNA level, male gender, older age, high ALT, positive HBeAg, HBV genotype C, and core promoter mutations are independently associated with higher HCC risk.
• HCC risk increases when HBV-DNA levels exceed 2,000 IU/mL.
• In patients with low viral load (<2,000 IU/mL), HBsAg level ≥1,000 IU/mL is a novel independent risk factor for HCC.

Conclusions:

• HBsAg level serves as a valuable complement to HBV-DNA level for risk stratification of disease progression in Asian adults with chronic HBV infection.
• Risk prediction models like REACH-B, incorporating HBV-DNA, HBsAg, and ALT, aid in categorizing HCC risk and guiding management.
• Further enhancement of predictive power may be achieved with tools like transient elastography.