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Did you know?

The morbidity and mortality associated with HBV will continue to increase through 2030 in the absence of additional interventions1

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Understanding the hepatocellular carcinoma (HCC) risk of going untreated

At-risk liver

HBV-related oncogenesis may occur at ANY phase of infection, even during the early stages of chronic hepatitis B2

HBV-related oncogenesis may occur at any phase of infection HBeAg+ chronic infection HBeAg+ chronic hepatitis HBeAg− chronic hepatitis HBsAg− phase HBeAg− chronic infection
HBV-related oncogenesis may occur at any phase of infection HBeAg+ chronic infection HBeAg+ chronic hepatitis HBeAg− chronic infection HBeAg− chronic hepatitis HBsAg− phase
Direct and indirect mechanisms influence the risk of HCC, begin at early stages of tumor development, and can occur at any phase of HBV infection3-5

Direct Mechanisms

Direct mechanisms

Direct mechanisms refer to the ability of HBV to integrate into the host genome, leading to potentially carcinogenic chromosomal aberrations and protein expression

Indirect Mechanisms

Indirect mechanisms

Indirect mechanisms are those that allow HBV to induce continuous, recurring liver necroinflammation, which may culminate in the development of cirrhosis

Higher HBV DNA levels are associated with increased risk of cirrhosis and HCC6,7

Higher HBV DNA levels are associated with increased risk of cirrhosis and HCC 12 10 8 6 4 2 0 <300 300-9999 10,000- 99,999 Viral Load (copies/mL) Crude hazard ratio of HCC >2000 IU/ mL 100,000- 999,999 ≥1 Million
  • Risk for HCC was significantly higher in those with baseline HBV DNA >2000 IU/mL (>10,000 copies/mL)
  • HCC can develop in patients with chronic hepatitis B with or without cirrhosis8

Populations at risk and screening recommendations

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Who is at risk for chronic hepatitis B?

In the US, Asians have the highest prevalence of HBV infection9,a

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African-born people in the US also have a higher prevalence of chronic hepatitis B compared with the general population10,b

aAs compared with other ethnic groups and the total population in the US.

bAs compared with other foreign-born people in the US.

Centers for Disease Control and Prevention (CDC) recommendations for universal screening and vaccination:

All adults aged ≥18 years should be tested at least once during their lifetime for hepatitisB11

All adults aged 19-59 years previously unvaccinated against HBV infection should receive hepatitis B vaccination11

CDC recommends periodic testing

CDC recommends periodic testing of people who are at increased risk for exposure to HBV11

This includes, but is not limited to, people with a history of sexually transmitted infections or multiple sex partners, those with a history of past or current HCV infection, and people born in regions with higher HBV infection prevalence11

Take action

4 points to discuss with your patients about chronic hepatitis B treatment

  1. Provide effective counseling and education about long-term effects of hepatitis B to help patients understand the severity of the disease
    • Inform all patients with elevated HBV DNA that they could have an increased risk of HCC, and that HBV-related oncogenesis may occur even during the early stages of chronic hepatitis B3
  2. Follow up with patients to ensure they understand the importance and goals of treatment
  3. Inform patients that treatment support programs (patient assistance programs, co-pay cards, peer support) may be available, if applicable
  4. Discuss treatment adherence with patients
    • Engage in an open dialogue and listen carefully to their concerns
    • Urge patients to take their chronic hepatitis B medicine exactly as prescribed12
    • Suggest medication reminder tools
    • Encourage lifestyle changes for liver health13
Learn more about treatment options

Interested in learning about a treatment option for your patients with chronic hepatitis B?

Learn about a treatment option

Consider the impact of comorbidities

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In the US, the chronic hepatitis B patient population is growing older and has more comorbidities as they age14,15

Renal function typically decreases with age

Renal function typically decreases with age, and renal impairment (eg, CKD, ESRD) is observed more frequently in patients with chronic hepatitis B than in uninfected people16-18

Bone density may decrease with age

Bone density may decrease with age, and osteoporosis and bone fracture are observed more frequently in patients with chronic hepatitis B than in uninfected people15,19

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Individuals of Asian descent may have an increased risk of bone fragility20

Some comorbidities that are more prevalent in patients with chronic hepatitis B include15:
  • Renal impairments (eg, CKD, ESRD)
  • Hypertension
  • Diabetes
  • Osteopenia and osteoporosis

CDC, Centers for Disease Control and Prevention; CKD, chronic kidney disease; ESRD, end-stage renal disease; HBeAg, hepatitis B e-antigen; HBsAg, hepatitis B surfac antigen; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; US, United States.

References:
  1. Razavi-Shearer D, Gamkrelidze I, Pan CQ, et al. The impact of immigration on hepatitis B burden in the United States: a modelling study. Lancet Reg Health Am. 2023;22:100516. doi:10.1016/j.lana.2023.100516
  2. Chauhan R, Michalak TI. Earliest hepatitis B virus-hepatocyte genome integration: sites, mechanism, and significance in carcinogenesis. Hepatoma Res. 2021; 7:20. doi:10.20517/2394-5079.2020.136
  3. Lupberger J, Hildt E. Hepatitis B virus-induced oncogenesis. World J Gastroenterol. 2007;13(1):74-81. doi:10.3748/wjg.v13.i1.74
  4. Levrero M, Zucman-Rossi J. Mechanisms of HBV-induced hepatocellular carcinoma. J Hepatol. 2016;64(suppl 1):S84-S101.doi:10.1016/j.jhep.2016.02.021
  5. Salpini R, D'Anna S, Benedetti L, et al. Hepatitis B virus DNA integration as a novel biomarker of hepatitis B virus-mediated pathogenetic properties and a barrier to the current strategies for hepatitis B virus cure.Front Microbiol. 2022;13:972687. doi:10.3389/fmicb.2022.972687
  6. Chen CJ, Yang HI, Su J, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295(1):65-73. doi:10.1001/jama.295.1.65
  7. Sinn DH, Lee J, Goo J, et al. Hepatocellular carcinoma risk in chronic hepatitisB virus-infected compensated cirrhosis patients with low viral load. Hepatology. 2015;62(3):694-701. doi:10.1002/hep.27889
  8. Lim YS, Kim WR, Dieterich D, et al. Evidence for benefits of early treatment initiation for chronic hepatitis B. Viruses. 2023;15(4):997.doi:10.3390/v15040997
  9. Kim H, Rotundo L, Yang J, et al. Racial/ethnic disparities in the prevalence and awareness of Hepatitis B virus infection and immunity in the United States.J Viral Hepat. 2017;24(11):1052-1066.
  10. Kowdley K, Wang C, Welch S, et al. Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology. 2012;56(2):422-433.
  11. Centers for Disease Control and Prevention. Screening and testing for hepatitis B virus infection: CDC recommendations—United States, 2023. MMWR Recomm Rep. 2023;72(1):1–25. doi:10.15585/mmwr.rr7201a1
  12. National Institutes of Health. National Library of Medicine.Hepatitis B. Medline Plus.Updated March 31, 2024.Accessed June 12, 2025. https://medlineplus.gov/ency/article/000279.htm
  13. Adults living with hepatitis B: healthy liver tips. Hepatitis B Foundation. Accessed June 12, 2025. https://www.hepb.org/treatment-and-management/adults-with-hepatitis-b/healthy-liver-tips
  14. Liu A, Le A, Zhang J, et al. Increasing co-morbidities in chronic hepatitis B patients: experience in primary care and referral practices during 2000-2015. Clin Transl Gastroenterol. 2018;9(3):141.
  15. Nguyen M, Lim J, Burak Ozbay A, et al. Advancing age and comorbidity in a US insured population-based cohort of patients with chronic hepatitis B. Hepatology. 2019;69(3):959-973.
  16. Chen YC, Su YC, Hung SK, et al. 13-year nationwide cohort study of chronic kidney disease risk among treatment-naïve patients with chronic hepatitis B in Taiwan. BMC Nephrology. 2015;16:110.
  17. Chen YC, Su YC, Li CY, et al. A nationwide cohort study suggests chronic hepatitis B virus infection increases the risk of end-stage renal disease among patients in Taiwan. Kidney Int. 2015;87(5):1030-1038.
  18. National Kidney Foundation. Clinical practice guidelines: For chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis. 2002;39(2 suppl 1):S1-S266.
  19. Demontiero O, Vidal C, Duque G. Aging and bone loss: new insights for the clinician. Ther Adv Musculoskelet Dis. 2012;4(2):61-76.
  20. Looker AC, Isfahani NS, Fan B, Shepherd JA. Trends in osteoporosis and low bone mass in older US adults, 2005-2006 through 2013-2014. Osteoporos Int. 2017;28(6):1979-1988. doi: 10.1007/s00198-017-3996-1