Related Experiment Video
Updated: Jun 24, 2025
A Competent Hepatocyte Model Examining Hepatitis B Virus Entry through Sodium Taurocholate Cotransporting Polypeptide as a Therapeutic Target
Published on: May 10, 2022
[Chronic hepatitis B: from "treat only if" to "treat all"]
1Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China.
Insights
Current chronic hepatitis B treatment strategies are insufficient. A "treat all" approach for patients with detectable HBV DNA is proposed to meet the World Health Organization's elimination goals.
Area of Science:
- Hepatology
- Virology
- Public Health
Context:
- Previous chronic hepatitis B treatment guidelines focused on high-risk patients with complications.
- International guidelines employed a "treat only if..." strategy, leading to undertreatment.
- A significant percentage of hepatocellular carcinoma (HCC) cases occurred in patients not meeting these criteria.
Purpose:
- To evaluate the evolution of chronic hepatitis B treatment strategies.
- To highlight the inadequacy of existing criteria in preventing complications like HCC.
- To propose a new strategy aligned with global health objectives.
Summary:
- The
- treat only if...
- strategy for chronic hepatitis B has been superseded by
- treat all except...
- due to its limitations.
- The
- treat all except...
- strategy increased treatment coverage but remains below targets.
- A
- treat all
- strategy, treating all positive HBV DNA patients, is now advocated.
Impact:
- The shift in strategy aims to improve patient outcomes and reduce chronic hepatitis B prevalence.
- Expanded treatment criteria are crucial for achieving the World Health Organization's hepatitis B elimination targets by 2030.
- Early treatment of all positive HBV DNA patients is essential for disease control and prevention of liver cancer.
Abstract:
The previous treatment criteria for chronic hepatitis B were based on the risk of complications occurring. International guidelines recommended treating only high-risk patients who developed complications, which was called the "treat only if..." strategy. Later, it was found that 33.5%~64.0% of the cases that developed hepatocellular carcinoma (HCC) did not meet the treatment criteria of international guidelines, suggesting that the treatment criteria for chronic hepatitis B need to be expanded. Following this, the "treat only if..." strategy was replaced by the "treat all except..." strategy. The latter is to treat all except patients at very low risk of complications. The proportion of patients with chronic hepatitis B who meet this strategy has risen from 10.3% to 26.5%~33.9%, but it is still far from the World Health Organization's proposed treatment target of 80%. Therefore, in an attempt to achieve the goal of eliminating hepatitis B by 2030, a "treat all" strategy has been proposed, wherein all chronic hepatitis B patients who test positive for HBV DNA should be treated as early as possible.
