2021 消化系聯合學術演講年會
外賓演講（二） CHRONIC HEPATITIS B: ANTIVIRAL THERAPIES AND HEPATOCELLULAR CARCINOMA Mindie H. Nguyen Division of Gastroenterology and Hepatology and Liver Transplant at Stanford University Medical Center, Palo Alto, CA, USA
Despite the availability of effective and safe hepatitis B vaccine for a few decades, chronic hepatitis B still affects approximately 290 million people worldwide according to a 2016 estimate. Several effective and safe oral medications have also become available in the past two decades, but a large number of patients with chronic hepatitis B continue to die prematurely due to end-stage liver failure related to cirrhosis and hepatocellular carcinoma (HCC). Strong observational as well as clinical trial data have shown that antiviral treatment with oral nucleos(t)ides are effective in lowering the risk of HCC development. More recent data have also shown that oral nucleos(t)ide therapies are also effective in increasing the 5-year survival of chronic hepatitis B who already have HCC, including patients with severe liver dysfunction, advanced tumor stage, or those receiving only palliative or supportive care for HCC. However, antiviral therapy is severely underutilized even among patients with advanced liver
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disease. Only one in three U.S. patients with hepatitis B-related cirrhosis and only one in two patients with hepatitis B-related HCC received antiviral therapy at any time. In this same nationwide study of 153 million people with private health insurance from the U.S., only 15% of the chronic hepatitis B patient population in the U.S. have been diagnosed and only 5% have received antiviral therapy. Globally, only 10% of the world burden of chronic hepatitis B have been diagnosis and only about 1.6% are estimated to have received antiviral therapy. Therefore, to reduce morbidity and mortality for patients affected by hepatitis B, we need to develop better public health and clinical strategies for improved screening and diagnosis than the current risk-based strategies; we need to propose more practical treatment algorithm and initiate antiviral therapy in appropriate patients more timely; and we need to develop novel therapies with finite treatment duration and potential for cure.
