At the recent 33rd annual meeting of Asia–Pacific Association for the Study of Liver held at Kyoto, Japan (27th–31st March, 2024), a momentous step with far-reaching impact has been initiated by the launching of the new World Health Organization (WHO) guidelines on the management of chronic hepatitis B (CHB) infection [1, 2]. The new WHO guidelines, advocate for bold recommendations to treat all unless normal ALT and HBV DNA < 2000 IU/ml (if assay available) and no liver fibrosis and other risk factors. For over two decades, despite the availability of effective and low-cost measures in screening, treatment and cancer surveillance, there has been a considerable gap in bringing these services to our CHB patients. Consequently, little if any significant decline in the age-standardized incidence and mortality related to liver cancer has occurred. The annualized rate of change of global HBV-related mortality rate has remained almost unchanged at less than 0.4% between 2015 and 2017 [3]. One of the key issues contributing to this stagnation is the complexity of major HBV guidelines [4], which have imposed undue hurdles for policymakers in recognizing the gravity of “under-diagnosis”, “under-treatment” and “under-surveillance of cancer” in CHB patients, leading to a devasting escalation of hepatocellular carcinoma-related deaths worldwide. These guidelines were formulated based on limited research evidence rather than real-world big data, requiring robust and precise laboratory techniques which are not widely accessible to the resource-limited regions [4]. According to a recent cost-effectiveness analysis, based on decision-tree Markov state-transition model, expanding antiviral treatment to HBV-infected patients with ALT thresholds of 30 U/L for males and 19 U/L for females, with 80% treatment coverage for HBsAg-positive individuals aged 18–80 years, will be required to significantly diminish HBV-related morbidity and mortality [5]. This strategy, coupled with lowered generic drug costs and revised medical insurance subsidization policies, particularly in HBV-endemic countries like China, has the potential to significantly reduce HBV-related complications and deaths, aligning the global target of 65% reduction in HBV-related death [6]. These new WHO guidelines with the expanding treatment criteria were echoed by the HBV guidelines published by China [7] and APASL Viral Elimination Taskforce [8]. Hopefully, in the very near future, as nations embrace these guidelines and scale-up diagnosis and treatment to achieve the WHO hepatitis elimination targets, we will witness a curtail of suffering of our chronic hepatitis B patients and their love ones, offering hope akin to the blossoming cherry trees in Kyoto!
Acknowledgements
Members of APASL Viral Elimination Taskforce (in no particular order): George LAU, Humanity and Health Clinical Trial Center, Humanity and Health Medical Group, Hong Kong SAR, China; Masao OMATA, Yamanashi Hospitals (Central and Kita) Organization, Kofu-shi, Yamanashi, Japan; Jidong JIA, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Hui ZHUANG, Department of Microbiology and Centre for Infectious Diseases, Peking University Health Science Centre, Beijing, China; Yu-Mei WEN, Key Laboratory Medical Molecular Virology, Ministry of Education/Health, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China; Xinxin ZHANG, Department of Infectious Disease, Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China; Jin Mo YANG, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; Tawesak TANWANDEE, Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand; Diana PAYAWAL, Department of Medicine, Cardinal Santos Medical Center, Mandaluyong, Philippines; Saeed HAMID, Aga Khan University, Karachi, Pakistan; Shiv Kumar SARIN, Rakhi MAIWALL, Manoj KUMAR, Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India; Jing CHEN, JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China; Dong JI, Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China; Wenhong ZHANG, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China; Fusheng WANG, Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing China; Jiangao FAN, Center for Fatty Liver, Department of Gastroenterology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Lungen LU, Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Xiaoguang DOU, Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang, China; Xiaolong QI, Center of portal hypertension, Department of radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China; Qin NING, Department and Institute of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Ming-Lung YU, Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan & School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan; Jacob GEORGE, School of Medicine, University of Sydney, Sydney, New South Wales, Australia; George BB GOH, Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Duke-NUS Graduate Medical School, Singapore; Sang Hoon AHN, Department of Internal Medicine, Institute of Gastroenterology, Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, South Korea; Rino Alvani GANI, Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia; Mohd Ismail MERICAN, Ministry of Health, Malaysia, Kuala Lumpur; Khin Maung WIN, Yangon GI & Liver Centre, Yangon, Myanmar; Oidov BAATARKHUU, Department of Infectious Diseases, Mongolian National University of Medical Sciences, Mongolia; Hasmik GHAZINYAN, Department of Hepatology, Nork Clinical Infectious Hospital (CJSC), Yerevan, Armenia; Manal H EL-SAYED, Department of Pediatrics, Faculty of Medicine, Clinical Research Center, Ain Shams University, Cairo, Egypt; Anuchit CHUTAPUTTI, Department of Medicine, Section of Digestive and Liver Diseases, Phramongkutklao Hospital, Bangkok, Thailand; Phunchai CHARATCHAROENWITTHAYA, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand; Pei-jer CHEN, Jia-Horng KAO, Department of Internal Medicine, Division of Gastroenterology and Hepatology, National Taiwan University Hospital, Taipei, Taiwan; Rosmawati MOHAMED, Department of Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Rakesh AGGARWAL, Department of Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India; Alexander THOMPSON, St. Vincent’s Hospital Melbourne and the University of Melbourne, Melbourne, Australia; Hong YOU, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Hong REN, Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Jian SUN, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China; Yoon Jun KIM, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea; Grace WONG, Department of Medicine & Therapeutics; Medical Data Analytics Centre (MDAC) & Center for Liver Health, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Fu GAO, CAS Key laboratory of Pathogenic Microbiology & Immunology, Institute of Microbiology Chinese Academy of Sciences, Beijing, China; Gang LI, Department of Infectious Diseases, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Jun-Qi NIU, Department of Hepatology, Center for Pathogen Biology and Infectious Diseases, First Hospital of Jilin University, Changchun, Jilin Province, China; Yu WANG, Chinese Foundation for Hepatitis Prevention and Control, China; Zhi-Liang GAO, Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Funding
The authors have not disclosed any funding.
Declarations
Conflicts of interest
Jing Chen, Ji-Dong Jia, Hui Zhuang, Yu-Mei Wen, Shiv Kumar Sarin, Masao Omata, George Lau, APASL Viral Elimination Taskforce have no conflicts to report.
Footnotes
The complete details of author involved in APASL Viral Elimination Taskforce are given in acknowledgements.
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Contributor Information
Jing Chen, Email: jingchen001@cuhk.edu.hk.
George Lau, Email: gkklau@hnhmgl.com, Email: gkklau@netvigator.com.
On behalf of APASL Viral Elimination Taskforce (in no particular order):
George Lau, Masao Omata, Jidong Jia, Hui Zhuang, Yu-Mei Wen, Xinxin Zhang, Jin Mo Yang, Tawesak Tanwandee, Diana Payawal, Saeed Hamid, Shiv Kumar Sarin, Rakhi Maiwall, Manoj Kumar, Jing Chen, Dong Ji, Wenhong Zhang, Fusheng Wang, Jiangao Fan, Lungen Lu, Xiaoguang Dou, Xiaolong Qi, Qin Ning, Ming-Lung Yu, Jacob George, George B. B. Goh, Sang Hoon Ahn, Rino Alvani Gani, Mohd Ismail Merican, Khin Maung Win, Oidov Baatarkhuu, Hasmik Ghazinyan, Manal H. El-Sayed, Anuchit Chutaputti, Phunchai Charatcharoenwitthaya, Pei-Jer Chen, Jia-Horng Kao, Rosmawati Mohamed, Rakesh Aggarwal, Alexander Thompson, Hong You, Hong Ren, Jian Sun, Yoon Jun Kim, Grace Wong, Fu Gao, Gang Li, Jun-Qi Niu, Yu Wang, and Zhi-Liang Gao
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