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Updated: Jun 25, 2025
Author Spotlight: Advancements and Challenges in Hepatitis B Virus Detection
Published on: December 15, 2023
Treatment decisions based on HBV DNA
1Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Insights
Antiviral treatment for chronic hepatitis B virus (HBV) infection can prevent liver cancer (HCC). Treatment decisions should prioritize HBV DNA levels and age over ALT levels to reduce HCC risk in CHB patients.
Area of Science:
- Hepatology
- Virology
- Oncology
Background:
- Chronic hepatitis B virus (HBV) infection is a leading cause of hepatocellular carcinoma (HCC) globally.
- Antiviral therapy suppresses HBV replication, reducing HCC risk and mortality, yet global treatment rates remain low (2.2% in 2019).
- Current guidelines often base treatment decisions on alanine aminotransferase (ALT) levels or liver biopsy, potentially delaying care.
Purpose of the Study:
- To review evidence linking serum HBV DNA levels to HCC risk in chronic hepatitis B (CHB) patients.
- To advocate for a revised treatment strategy based on HBV DNA levels and patient age.
- To assess the impact and cost-effectiveness of early antiviral treatment initiation.
Main Methods:
- Systematic review of existing literature on HBV DNA levels, HCC risk, and antiviral treatment outcomes.
- Analysis of the non-linear parabolic association between HBV DNA and HCC risk.
- Collating data on the potential impact and cost-effectiveness of early treatment.
Main Results:
- Serum HBV DNA levels are significantly associated with HCC risk in both treated and untreated CHB patients.
- This association follows a non-linear parabolic pattern, independent of HBeAg status or ALT levels.
- Evidence suggests early treatment initiation based on HBV DNA levels and age is beneficial.
Conclusions:
- Antiviral treatment decisions for CHB should prioritize serum HBV DNA levels and age, not solely ALT levels or liver biopsy.
- A proactive treatment approach based on viral load can significantly reduce HCC incidence.
- Early intervention is crucial for mitigating HCC risk and improving outcomes in CHB patients.
Abstract:
The most common cause of hepatocellular carcinoma (HCC) worldwide is chronic hepatitis B virus (HBV) infection (CHB). Long-term suppression of HBV replication by antiviral treatment reduces the risk of HCC and mortality. Nonetheless, only 2.2% of CHB patients globally received the treatment in 2019. Current international CHB guidelines recommend antiviral treatment only in subsets of patients with clear evidence of liver damage as evidenced by elevation of alanine aminotransferase (ALT). This review aims to provide existing evidence that the risk of HCC is significantly associated with serum levels of HBV DNA, and the association is non-linear parabolic, in both untreated and treated CHB patients, regardless of HBeAg status or ALT levels. Therefore, the decision for the antiviral treatment should be based on serum HBV DNA levels and age, rather than ALT levels or liver biopsy, to reduce or prevent the risk of HCC in CHB patients. The potential impact and cost-effectiveness data on early antiviral treatment initiation were also collated.
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