| Invited Lecture(JSGE) |
| Fri. November 1st 15:00 - 15:30 Room 9: Portopia Hotel Main Building Kairaku 3 |
| Paradigm shift in HBV treatment guidelines | |||
| Sang Hoon Ahn | |||
| Department of Internal Medicine, Yonsei University College of Medicine | |||
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| Chronic hepatitis B (CHB) is a significant and urgent public health issue. Timely identification and effective antiviral therapy have the potential to significantly reduce liver-related mortality caused by chronic hepatitis B virus (HBV) infection. However, current treatments do not eliminate HBV, and most patients require long-term therapy to maintain clinical benefits. As a result, most of international guidelines do not recommend treating all patients with chronic HBV infection, contributing to the globally low treatment rates for CHB due to the stringent criteria of national CHB guidelines. There is a growing need for a new paradigm in classifying CHB patients, broadening the eligibility for antiviral treatment, and streamlining the diagnostic process to enhance cost-effectiveness and improve survival rates. Current CHB management guidelines are complex and only recommend antiviral treatment for patients with elevated ALT levels and significant serum HBV DNA levels. The strict and complicated nature of these guidelines has led to only 2.2% of global CHB patients receiving antiviral treatment in 2019. This is in stark contrast to hepatitis C or HIV, where recent guidelines have promoted early treatment for all infected individuals, regardless of end-organ damage. Multiple studies indicate that patients currently ineligible for antiviral treatment may have a significant or even the highest risk of developing HCC. Therefore, it is time to consider simplified and expanded treatment strategies based on viral load to reduce HCC risk. On March 29, 2024, the WHO introduced new guidelines for the prevention, diagnosis, and treatment of chronic hepatitis B infection. These new guidelines simplify the treatment criteria for CHB and expand patient eligibility, removing several barriers to accessing testing and treatment. The updated guidelines include treatment criteria for not only adults but also adolescents (aged 12 years and older), potentially increasing treatment eligibility to at least 50% of people with hepatitis B, compared to only 8-15% in the past. Available molecular, clinical, and economic data strongly support the earlier initiation of antiviral treatment in CHB patients to reduce the risk of HCC. Adopting a simplified 'treat to prevent' approach and expansion of treatment are changing trends of HBV treatment guidelines. |
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