ASO: antisense oligonucleotides; HBeAg: hepatitis B e antigen; HBsAg: hepatitis B surface antigen; HBV: hepatitis B virus; HCV: hepatitis C virus; HIV: human immunodeficiency virus; siRNA: small interfering RNA
Declarations
Author contributions
JCTL and VWKH: Writing—original draft, Writing—review & editing. GLHW, VWSW, and TCFY: Conceptualization, Writing—original draft, Writing—review & editing. All authors read and approved the submitted version.
Conflicts of interest
JCTL and VWKH declare that they have no conflicts of interest. GLHW has served as an advisory committee member for AstraZeneca, Gilead Sciences, and Janssen, and as a speaker for Abbott, AbbVie, Ascletis, Bristol-Myers Squibb, Echosens, Gilead Sciences, Janssen, and Roche. She has also received a research grant from Gilead Sciences. VWSW has served as a consultant or advisory committee member for AbbVie, Boehringer Ingelheim, Echosens, Intercept, Inventiva, Novo Nordisk, Pfizer, and TARGET PharmaSolutions; and a speaker for Abbott, AbbVie, Gilead Sciences, and Novo Nordisk. He has received a research grant from Gilead Sciences, and is a cofounder of Illuminatio Medical Technology Limited. TCFY has served as an advisory committee member and a speaker for Gilead Sciences.
Polaris Observatory Collaborators. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study.Lancet Gastroenterol Hepatol. 2023;8:879–907. [DOI] [PubMed]
Yip TC, Wong GL, Wong VW, Tse YK, Lui GC, Lam KL, et al. Durability of hepatitis B surface antigen seroclearance in untreated and nucleos(t)ide analogue-treated patients.J Hepatol. 2018;68:63–72. [DOI] [PubMed]
Yip TC, Wong GL, Chan HL, Tse YK, Lam KL, Lui GC, et al. HBsAg seroclearance further reduces hepatocellular carcinoma risk after complete viral suppression with nucleos(t)ide analogues.J Hepatol. 2019;70:361–70. [DOI] [PubMed]
Ghany MG, Buti M, Lampertico P, Lee HM; 2022 AASLD-EASL HBV-HDV Treatment Endpoints Conference Faculty. Guidance on treatment endpoints and study design for clinical trials aiming to achieve cure in chronic hepatitis B and D: report from the 2022 AASLD-EASL HBV-HDV Treatment Endpoints Conference.J Hepatol. 2023;79:1254–69.
Yip TC, Chan HL, Wong VW, Tse YK, Lam KL, Wong GL. Impact of age and gender on risk of hepatocellular carcinoma after hepatitis B surface antigen seroclearance.J Hepatol. 2017;67:902–8. [DOI] [PubMed]
Yip TC, Wong VW, Lai MS, Lai JC, Hui VW, Liang LY, et al. Risk of hepatic decompensation but not hepatocellular carcinoma decreases over time in patients with hepatitis B surface antigen loss.J Hepatol. 2023;78:524–33. [DOI] [PubMed]
Yip TC, Wong GL. Current knowledge of occult hepatitis B infection and clinical implications.Semin Liver Dis. 2019;39:249–60. [DOI] [PubMed]
Raimondo G, Locarnini S, Pollicino T, Levrero M, Zoulim F, Lok AS, et al. Update of the statements on biology and clinical impact of occult hepatitis B virus infection.J Hepatol. 2019;71:397–408. [DOI] [PubMed]
Gao N, Guan G, Xu G, Wu H, Xie C, Mo Z, et al. Integrated HBV DNA and cccDNA maintain transcriptional activity in intrahepatic HBsAg-positive patients with functional cure following PEG-IFN-based therapy.Aliment Pharmacol Ther. 2023;58:1086–98. [DOI] [PubMed]
Yeo YH, Ho HJ, Yang HI, Tseng TC, Hosaka T, Trinh HN, et al. Factors associated with rates of HBsAg seroclearance in adults with chronic HBV infection: a systematic review and meta-analysis.Gastroenterology. 2019;156:635–46, e9. [DOI] [PubMed]
Terrault NA, Wahed AS, Feld JJ, Cooper SL, Ghany MG, Lisker-Melman M, et al. Incidence and prediction of HBsAg seroclearance in a prospective multi-ethnic HBeAg-negative chronic hepatitis B cohort.Hepatology. 2022;75:709–23. [DOI] [PubMed] [PMC]
Huang SC, Su TH, Tseng TC, Chen CL, Hsu SJ, Liu CH, et al. Metabolic dysfunction-associated steatotic liver disease facilitates hepatitis B surface antigen seroclearance and seroconversion.Clin Gastroenterol Hepatol. 2024;22:581–90, e6. [DOI] [PubMed]
Chen YC, Jeng WJ, Chu CM, Liaw YF. Decreasing levels of HBsAg predict HBsAg seroclearance in patients with inactive chronic hepatitis B virus infection.Clin Gastroenterol Hepatol. 2012;10:297–302. [DOI] [PubMed]
Liang LY, Wong VW, Wong GL, Yip TC. Moving toward hepatitis B virus functional cure - the impact of on-treatment kinetics of serum viral markers.Clin Mol Hepatol. 2023;29:113–7. [DOI] [PubMed] [PMC]
Yip TC, Wong VW, Tse YK, Chan HL, Wong GL. Hepatitis B surface antigen seroclearance in a cohort of 154,740 patients with chronic hepatitis B: a 15-year follow-up study. APASL 2017: Proceedings of the 26th Annual Conference of APASL; 2017 Feb 15–19. Shanghai, China. Berlin: Springer; 2017. pp. 75–6.
Bruden D, McMahon BJ, Snowball M, Towshend-Bulson L, Homan C, Johnston JM, et al. Rate and durability of clearance of HBsAg in Alaska Native persons with long-term hepatitis B virus infection: 1982-2019.Hepatology. 2023;[Epub ahead of print]. [DOI] [PubMed]
Sonneveld MJ, Chiu SM, Park JY, Brakenhoff SM, Kaewdech A, Seto WK, et al. Lower pretreatment HBV DNA levels are associated with better off-treatment outcomes after nucleo(s)tide analogue withdrawal in patients with HBeAg-negative chronic hepatitis B: a multicentre cohort study.JHEP Rep. 2023;5:100790. [DOI] [PubMed] [PMC]
Sonneveld MJ, Chiu SM, Park JY, Brakenhoff SM, Kaewdech A, Seto WK, et al. HBV DNA and HBsAg levels at 24 weeks off-treatment predict clinical relapse and HBsAg loss in HBeAg-negative patients who discontinued antiviral therapy.Gastroenterology. 2024;166:168–77, e8. [DOI] [PubMed]
Sonneveld MJ, Chiu SM, Park JY, Brakenhoff SM, Kaewdech A, Seto WK, et al. Probability of HBsAg loss after nucleo(s)tide analogue withdrawal depends on HBV genotype and viral antigen levels.J Hepatol. 2022;76:1042–50. [DOI] [PubMed]
Yip TC, Brunetto MR. Hepatitis B surface antigen seroclearance is uncommon but durable in the long run.Hepatology. 2023;[Epub ahead of print]. [DOI] [PubMed]
Yu ML, Lee CM, Chen CL, Chuang WL, Lu SN, Liu CH, et al. Sustained hepatitis C virus clearance and increased hepatitis B surface antigen seroclearance in patients with dual chronic hepatitis C and B during posttreatment follow-up.Hepatology. 2013;57:2135–42. [DOI] [PubMed]
Wiegand SB, Jaroszewicz J, Potthoff A, Honer Zu Siederdissen C, Maasoumy B, Deterding K, et al. Dominance of hepatitis C virus (HCV) is associated with lower quantitative hepatitis B surface antigen and higher serum interferon-γ-induced protein 10 levels in HBV/HCV-coinfected patients.Clin Microbiol Infect. 2015;21:710, e1–9. [DOI] [PubMed]
Chihota BV, Wandeler G, Chilengi R, Mulenga L, Chung RT, Bhattacharya D, et al. High rates of hepatitis B virus (HBV) functional cure among human immunodeficiency virus-HBV coinfected patients on antiretroviral therapy in Zambia.J Infect Dis. 2020;221:218–22. [DOI] [PubMed] [PMC]
Mpebe GGA, Phinius BB, Mutenga S, Baruti K, Bhebhe L, Choga WT, et al. Hepatitis B surface antigen loss in individuals with chronic hepatitis B virus and HIV-1 infections in Botswana.AIDS. 2024;38:153–9. [DOI] [PubMed]
Audsley J, Bent SJ, Littlejohn M, Avihingsanon A, Matthews G, Bowden S, et al. Effects of long-term tenofovir-based combination antiretroviral therapy in HIV-hepatitis B virus coinfection on persistent hepatitis B virus viremia and the role of hepatitis B virus quasispecies diversity.AIDS. 2016;30:1597–606. [DOI] [PubMed]
Huang YS, Sun HY, Chang SY, Chuang YC, Cheng A, Huang SH, et al. Long-term virological and serologic responses of chronic hepatitis B virus infection to tenofovir disoproxil fumarate-containing regimens in patients with HIV and hepatitis B coinfection.Hepatol Int. 2019;13:431–9. [DOI] [PubMed]
Boyd A, Gozlan J, Miailhes P, Lascoux-Combe C, Cam MS, Rougier H, et al. Rates and determinants of hepatitis B ‘e’ antigen and hepatitis B surface antigen seroclearance during long-term follow-up of patients coinfected with HIV and hepatitis B virus.AIDS. 2015;29:1963–73. [DOI] [PubMed]
Yang R, Gui X, Ke H, Xiong Y, Gao S. Long-term observation on hepatitis B surface antigen seroclearance in therapy experienced HIV/HBV co-infected Chinese.J Viral Hepat. 2020;27:127–34. [DOI] [PubMed]
Wong YJ, Nguyen VH, Yang HI, Li J, Le MH, Wu WJ, et al. Impact of fatty liver on long-term outcomes in chronic hepatitis B: a systematic review and matched analysis of individual patient data meta-analysis.Clin Mol Hepatol. 2023;29:705–20. [DOI] [PubMed] [PMC]
Hirode G, Choi HSJ, Chen CH, Su TH, Seto WK, Van Hees S, et al. Off-therapy response after nucleos(t)ide analogue withdrawal in patients with chronic hepatitis B: an international, multicenter, multiethnic cohort (RETRACT-B Study).Gastroenterology. 2022;162:757–71, e4. [DOI] [PubMed]
Moini M, Fung S. HBsAg loss as a treatment endpoint for chronic HBV infection: HBV cure.Viruses. 2022;14:657. [DOI] [PubMed] [PMC]
Hsu YC, Yeh ML, Wong GL, Chen CH, Peng CY, Buti M, et al. Incidences and determinants of functional cure during entecavir or tenofovir disoproxil fumarate for chronic hepatitis B.J Infect Dis. 2021;224:1890–9. [DOI] [PubMed]
Hsu YC, Jun DW, Peng CY, Yeh ML, Trinh H, Wong GL, et al. Effectiveness of entecavir vs tenofovir disoproxil fumarate for functional cure of chronic hepatitis B in an international cohort.Hepatol Int. 2022;16:1297–307. [DOI] [PubMed]
Wong GL, Chan HL, Yuen BW, Tse YK, Luk HW, Yip TC, et al. The safety of stopping nucleos(t)ide analogue treatment in patients with HBeAg-negative chronic hepatitis B.Liver Int. 2020;40:549–57. [DOI] [PubMed]
Song A, Wang X, Lu J, Jin Y, Ma L, Hu Z, et al. Durability of hepatitis B surface antigen seroclearance and subsequent risk for hepatocellular carcinoma: a meta-analysis.J Viral Hepat. 2021;28:601–12. [DOI] [PubMed] [PMC]
Yip TC, Lok AS. How do we determine whether a functional cure for HBV infection has been achieved?Clin Gastroenterol Hepatol. 2020;18:548–50. [DOI] [PubMed]
Wu Y, Liu Y, Lu J, Cao Z, Jin Y, Ma L, et al. Durability of interferon-induced hepatitis B surface antigen seroclearance.Clin Gastroenterol Hepatol. 2020;18:514–6, e2. [DOI] [PubMed]
Kim MA, Kim SU, Sinn DH, Jang JW, Lim YS, Ahn SH, et al. Discontinuation of nucleos(t)ide analogues is not associated with a higher risk of HBsAg seroreversion after antiviral-induced HBsAg seroclearance: a nationwide multicentre study.Gut. 2020;69:2214–22. [DOI] [PubMed]
Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HL, Chen CJ, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update.Hepatol Int. 2016;10:1–98. [DOI] [PubMed] [PMC]
European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection.J Hepatol. 2017;67:370–98. [DOI] [PubMed]
Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.Hepatology. 2018;67:1560–99. [DOI] [PubMed] [PMC]
Wong GL, Wong VW, Yuen BW, Tse YK, Yip TC, Luk HW, et al. Risk of hepatitis B surface antigen seroreversion after corticosteroid treatment in patients with previous hepatitis B virus exposure.J Hepatol. 2020;72:57–66. [DOI] [PubMed]
Anderson M, Holzmayer V, Stec M, Cloherty G, Lim SG. Ultrasensitive HBsAg testing predicts HBsAg seroreversion outcomes: considerations for new and existing therapies.J Hepatol. 2023;[Epub ahead of print]. [DOI] [PubMed]
Wong GLH, Gane E, Lok ASF. How to achieve functional cure of HBV: stopping NUCs, adding interferon or new drug development?J Hepatol. 2022;76:1249–62. [DOI] [PubMed]
Hirode G, Hansen BE, Chen CH, Su TH, Wong G, Seto WK, et al. Incidence of hepatic decompensation after nucleos(t)ide analog withdrawal: results from a large, international, multiethnic cohort of patients with chronic hepatitis B (RETRACT-B Study).Am J Gastroenterol. 2023;118:1601–8. [DOI] [PubMed]
Lau G, Yu ML, Wong G, Thompson A, Ghazinian H, Hou JL, et al. APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy.Hepatol Int. 2021;15:1031–48. [DOI] [PubMed] [PMC]
Kim GA, Lee HC, Kim MJ, Ha Y, Park EJ, An J, et al. Incidence of hepatocellular carcinoma after HBsAg seroclearance in chronic hepatitis B patients: a need for surveillance.J Hepatol. 2015;62:1092–9. [DOI] [PubMed]
Bruix J, Sherman M; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update.Hepatology. 2011;53:1020–2. [DOI] [PubMed] [PMC]
Mak LY, Wong DK, Pollicino T, Raimondo G, Hollinger FB, Yuen MF. Occult hepatitis B infection and hepatocellular carcinoma: epidemiology, virology, hepatocarcinogenesis and clinical significance.J Hepatol. 2020;73:952–64. [DOI] [PubMed]
Yang H, Bae SH, Nam H, Lee HL, Lee SW, Yoo SH, et al. A risk prediction model for hepatocellular carcinoma after hepatitis B surface antigen seroclearance.J Hepatol. 2022;77:632–41. [DOI] [PubMed]
Hsu YC, Yip TC, Ho HJ, Wong VW, Huang YT, El-Serag HB, et al. Development of a scoring system to predict hepatocellular carcinoma in Asians on antivirals for chronic hepatitis B.J Hepatol. 2018;69:278–85. [DOI] [PubMed]
Yip TC, Wong VW, Chan HL, Tse YK, Kong AP, Lam KL, et al. Effects of diabetes and glycemic control on risk of hepatocellular carcinoma after seroclearance of hepatitis B surface antigen.Clin Gastroenterol Hepatol. 2018;16:765–73, e2. [DOI] [PubMed]
Chen YC, Jeng WJ, Chien RN, Chu CM, Liaw YF. Clinical outcomes after spontaneous and nucleos(t)ide analogue-treated HBsAg seroclearance in chronic HBV infection.Aliment Pharmacol Ther. 2016;43:1311–8. [DOI] [PubMed]
Yip TC, Wong VW, Tse YK, Liang LY, Hui VW, Zhang X, et al. Similarly low risk of hepatocellular carcinoma after either spontaneous or nucleos(t)ide analogue-induced hepatitis B surface antigen loss.Aliment Pharmacol Ther. 2021;53:321–31. [DOI] [PubMed]
Choi J, Yoo S, Lim YS. Comparison of long-term clinical outcomes between spontaneous and therapy-induced HBsAg seroclearance.Hepatology. 2021;73:2155–66. [DOI] [PubMed]
Lee HW, Yip TC, Wong VW, Lim YS, Chan HL, Ahn SH, et al. CAMP-B score predicts the risk of hepatocellular carcinoma in patients with chronic hepatitis B after HBsAg seroclearance.Aliment Pharmacol Ther. 2024;59:1223–35. [DOI] [PubMed]
Wong VW, Chan SL, Mo F, Chan TC, Loong HH, Wong GL, et al. Clinical scoring system to predict hepatocellular carcinoma in chronic hepatitis B carriers.J Clin Oncol. 2010;28:1660–5. [DOI] [PubMed]
Yang HI, Yuen MF, Chan HL, Han KH, Chen PJ, Kim DY, et al. Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B): development and validation of a predictive score.Lancet Oncol. 2011;12:568–74. [DOI] [PubMed]
Papatheodoridis G, Dalekos G, Sypsa V, Yurdaydin C, Buti M, Goulis J, et al. PAGE-B predicts the risk of developing hepatocellular carcinoma in Caucasians with chronic hepatitis B on 5-year antiviral therapy.J Hepatol. 2016;64:800–6. [DOI] [PubMed]
Kim JH, Kim YD, Lee M, Jun BG, Kim TS, Suk KT, et al. Modified PAGE-B score predicts the risk of hepatocellular carcinoma in Asians with chronic hepatitis B on antiviral therapy.J Hepatol. 2018;69:1066–73. [DOI] [PubMed]
Wong GL, Hui VW, Tan Q, Xu J, Lee HW, Yip TC, et al. Novel machine learning models outperform risk scores in predicting hepatocellular carcinoma in patients with chronic viral hepatitis.JHEP Rep. 2022;4:100441. [DOI] [PubMed] [PMC]
Kim HY, Lampertico P, Nam JY, Lee HC, Kim SU, Sinn DH, et al. An artificial intelligence model to predict hepatocellular carcinoma risk in Korean and Caucasian patients with chronic hepatitis B.J Hepatol. 2022;76:311–8. [DOI] [PubMed]
Lee HW, Kim H, Park T, Park SY, Chon YE, Seo YS, et al. A machine learning model for predicting hepatocellular carcinoma risk in patients with chronic hepatitis B.Liver Int. 2023;43:1813–21. [DOI] [PubMed]
Kim DH, Choi JI. Current status of image-based surveillance in hepatocellular carcinoma.Ultrasonography. 2021;40:45–56. [DOI] [PubMed] [PMC]
Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases.Hepatology. 2018;68:723–50. [DOI] [PubMed]
Omata M, Cheng AL, Kokudo N, Kudo M, Lee JM, Jia J, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update.Hepatol Int. 2017;11:317–70. [DOI] [PubMed] [PMC]
European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma.J Hepatol. 2018;69:182–236. [DOI] [PubMed]
Parikh ND, Singal AG, Hutton DW, Tapper EB. Cost-effectiveness of hepatocellular carcinoma surveillance: an assessment of benefits and harms.Am J Gastroenterol. 2020;115:1642–9. [DOI] [PubMed] [PMC]
Ahn JC, Lee YT, Agopian VG, Zhu Y, You S, Tseng HR, et al. Hepatocellular carcinoma surveillance: current practice and future directions.Hepatoma Res. 2022;8:10. [DOI] [PubMed] [PMC]
Wong VW, Janssen HL. Can we use HCC risk scores to individualize surveillance in chronic hepatitis B infection?J Hepatol. 2015;63:722–32. [DOI] [PubMed]
Singal A, Volk ML, Waljee A, Salgia R, Higgins P, Rogers MA, et al. Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis.Aliment Pharmacol Ther. 2009;30:37–47. [DOI] [PubMed] [PMC]
Singal AG, Tapper EB, Parikh ND. Cost-effectiveness of biomarker-based surveillance for hepatocellular carcinoma (Hcc) in patients with cirrhosis.Hepatology. 2022;76:S1389–90. [DOI]
Gopal P, Yopp AC, Waljee AK, Chiang J, Nehra M, Kandunoori P, et al. Factors that affect accuracy of α-fetoprotein test in detection of hepatocellular carcinoma in patients with cirrhosis.Clin Gastroenterol Hepatol. 2014;12:870–7. [DOI] [PubMed] [PMC]
European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma.J Hepatol. 2012;56:908–43. [DOI] [PubMed]
Best J, Bechmann LP, Sowa JP, Sydor S, Dechene A, Pflanz K, et al. GALAD score detects early hepatocellular carcinoma in an international cohort of patients with nonalcoholic steatohepatitis.Clin Gastroenterol Hepatol. 2020;18:728–35. e4.
Yip TC, Wong GL, Wong VW, Tse YK, Liang LY, Hui VW, et al. Reassessing the accuracy of PAGE-B-related scores to predict hepatocellular carcinoma development in patients with chronic hepatitis B.J Hepatol. 2020;72:847–54. [DOI] [PubMed]
Kim HS, Yu X, Kramer J, Thrift AP, Richardson P, Hsu YC, et al. Comparative performance of risk prediction models for hepatitis B-related hepatocellular carcinoma in the United States.J Hepatol. 2022;76:294–301. [DOI] [PubMed] [PMC]
Yip TC, Hui VW, Tse YK, Wong GL. Statistical strategies for HCC risk prediction models in patients with chronic hepatitis B.Hepatoma Res. 2021;7:7. [DOI]
Fan R, Chen L, Zhao S, Yang H, Li Z, Qian Y, et al. Novel, high accuracy models for hepatocellular carcinoma prediction based on longitudinal data and cell-free DNA signatures.J Hepatol. 2023;79:933–44. [DOI] [PubMed]
Kawka M, Dawidziuk A, Jiao LR, Gall TMH. Artificial intelligence in the detection, characterisation and prediction of hepatocellular carcinoma: a narrative review.Transl Gastroenterol Hepatol. 2022;7:41. [DOI] [PubMed] [PMC]
Liang KH, Hsu CW, Chang ML, Chen YC, Lai MW, Yeh CT. Peginterferon is superior to nucleos(t)ide analogues for prevention of hepatocellular carcinoma in chronic hepatitis B.J Infect Dis. 2016;213:966–74. [DOI] [PubMed]