Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world and the second leading cause of cancer death. Hepatitis B virus (HBV) infection is one of the major risk factors for the development of HCC in the world. Most of the burden of disease (85%) is observed in the HBV endemic regions. Chronic infection with HBV predisposes patients with or without cirrhosis to HCC. Patients with high HBV DNA levels are at an increased risk for HCC. Studies have shown that the suppression of HBV with anti-viral therapy (nucleos(t)ide analogs) (NAs) decreases the incidence of HCC but does not eliminate the risk entirely. Chronic viral suppression alone is not sufficient treatment to prevent HCC development. Therefore, along with NAs, treatment may need to include targeting the cccDNA and inhibiting the viral entry into the newly formed hepatocytes and T-cell vaccine which specifically targets HBV and enhancing innate immunity with Toll-like receptor agonist. With all of these working together, we may achieve the goal of HBV cure.
Part of the book: Updates in Liver Cancer
Since the discovery of the hepatitis B virus (HBV) by Blumberg et al., nearly half a century ago, the subsequent development of a vaccine, understanding of the pathogenesis, and the advent of antiviral drugs, the prevalence of chronic hepatitis B has decreased from approximately 5% to 3.61% of the worldwide population. Despite this improvement, approximately 248 million individuals are still infected with the virus. Effective treatment of chronic hepatitis B is extremely important as a positive correlation has been observed between baseline viral load and the risk for the development of hepatocellular carcinoma (HCC). While there have been significant advancements in the management of hepatitis B virus with available nucleos(t)ide analogues, there remains much work to be done to prevent HCC. The molecular mechanism and the subsequent carcinogenesis and progression of chronic HBV carriers to HCC remain in large part poorly understood. While current treatment with nucleos(t)ide analogues has succeeded in maintaining undetectable viral levels in patients with chronic hepatitis B, eradication of the virus has not been possible, and there remains the risk of development of HCC. Therefore, more effective treatment regimens aiming for HBV cure are urgently needed. With multiple new therapies in the pipeline, the future of treating hepatitis B is an exciting and developing one, and hopefully, it will soon become a disease of the past.
Part of the book: Advances in Treatment of Hepatitis C and B