Chronic hepatitis B: Is it time for expanded antiviral treatment?

An estimated 3%-4% of people are living with the hepatitis B virus (HBV), and without treatment, the risk of developing cirrhosis and hepatocellular cancer (HCC) is an omnipresent threat. Prevention of HCC is a major challenge, as the association between viral suppression and HCC risk reduction is multifactorial, involving the progressive depletion of hepatocytes through covalently closed circular DNA integration, as well as the prevention of liver fibrosis and cirrhosis. Despite effective and cheap antiviral treatment capable of suppressing HBV replication and thereby cirrhosis and HCC, the current indications for therapy need revision and more research to expand the gamut and treat more infected people. In this review, we discuss the possible expansion of antiviral treatment in chronic hepatitis B to prevent cirrhosis and, importantly, HCC.