Hepatitis B Treatment Based on 'Virus Levels'... Can Prevent 3,000 Cases Annually

Seoul Asan Hospital Professor Lim Young-seok's Team Research
Liver Cancer Risk Varies According to Blood Virus Levels
"Revising Health Insurance Coverage Criteria for Hepatitis B Could Prevent 3,000 Liver Cancer Cases Annually"

A domestic research team has announced that to effectively reduce the incidence of liver cancer, treatment for hepatitis B should be initiated based on viral load rather than liver enzyme levels.

Relationship between viral load and liver cancer occurrence in chronic hepatitis B.
[Image provided by Seoul Asan Hospital]

Seoul Asan Medical Center revealed on the 7th that a team led by Professors Lim Young-seok and Choi Won-mook from the Department of Gastroenterology tracked the risk of liver cancer over several years in 9,709 adult patients with chronic hepatitis B, resulting in this finding.

Specifically, patients with a hepatitis B viral load of about 1 million units per 1 ml of blood (6 log10 IU/ml) showed the highest risk of developing liver cancer. Even during long-term hepatitis treatment, these patients only experienced about a 50% reduction in liver cancer risk but still maintained the highest risk level.

The research team discovered that as the hepatitis B viral load in patients' blood deviated from 1 million units, the risk of liver cancer gradually decreased. This means that both higher and lower viral loads correspond to a lower risk of occurrence. They were the first in the world to reveal that this relationship persists even during hepatitis treatment.

According to the current hepatitis B health insurance reimbursement criteria, treatment cannot be initiated if liver enzyme levels are normal, even when the viral load is high. The hospital explained that this study is significant as it suggests that early hepatitis treatment based on viral load, even when liver enzyme levels are normal, could reduce the number of liver cancer cases by up to one-sixth.

The research team followed 4,693 adult patients who started hepatitis B treatment at five university hospitals in Korea (Seoul Asan Medical Center, Kyung Hee University Hospital, Samsung Seoul Hospital, Seoul National University Hospital, Bundang Seoul National University Hospital) for an average of 7.6 years, during which 193 patients developed liver cancer. In contrast, among 5,016 patients who did not receive hepatitis treatment, 322 developed liver cancer. This suggests that hepatitis treatment overall reduces the risk of liver cancer by about 50%.

However, in both the treatment and non-treatment groups, patients with a viral load of 1 million units per 1 ml of blood (6 log10 IU/ml) had the highest risk of liver cancer. Conversely, patients with viral loads far from 1 million units?either very low (below 10,000 units) or very high (100 million units or more, ≥8 log10 IU/ml)?had the lowest risk of liver cancer.

In summary, the risk of liver cancer in untreated patients with a viral load of 1 million units was up to 6.1 times higher compared to patients who started treatment at viral loads of 100 million units or more.

Until now, the academic community believed that the risk of liver cancer increased linearly with viral load and that after starting hepatitis treatment, viral load was not associated with liver cancer risk. However, the research team concluded that to prevent liver cancer, it is best to initiate hepatitis treatment when the viral load is either very high (100 million units or more, ≥8 log10 IU/ml) or quite low (below 10,000 units).

Ultimately, to maintain a low risk of liver cancer, the research team concluded that the complex criteria for initiating hepatitis B treatment should be simplified to rely solely on blood viral load, and treatment should begin early. The current health insurance reimbursement criteria for hepatitis B treatment are very complicated, requiring a viral load of at least 2,000 units and liver enzyme levels (AST or ALT) at least twice the upper normal limit (80 IU/L).

Professor Lim Young-seok of the Department of Gastroenterology at Ulsan College of Medicine, Seoul Asan Medical Center, stated, "About 12,000 new liver cancer patients are diagnosed annually in Korea, mostly middle-aged men, leading to serious socioeconomic losses and family crises. Adult patients with a blood hepatitis B viral load of 2,000 IU/ml or higher should be allowed to start hepatitis treatment immediately regardless of liver enzyme levels by revising the health insurance reimbursement criteria. This could prevent about 3,000 cases of liver cancer annually and approximately 40,000 cases over the next 15 years," he emphasized.

Professor Lim added, "It has already been proven that simplifying and advancing the timing of hepatitis B treatment based on viral load reduces social cost burdens by preventing liver cancer."

Meanwhile, the study results were recently published online in 'GUT,' a leading journal in the field of gastroenterology.

Professors Lim Young-seok (left) and Choi Won-mook, Department of Gastroenterology, Asan Medical Center, Seoul.
[Photo by Asan Medical Center, Seoul]

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