[Chronic hepatitis B: from "treat only if" to "treat all"].

Abstract

The previous treatment criteria for chronic hepatitis B were based on the risk of complications occurring. International guidelines recommended treating only high-risk patients who developed complications, which was called the "treat only if..." strategy. Later, it was found that 33.5%~64.0% of the cases that developed hepatocellular carcinoma (HCC) did not meet the treatment criteria of international guidelines, suggesting that the treatment criteria for chronic hepatitis B need to be expanded. Following this, the "treat only if..." strategy was replaced by the "treat all except..." strategy. The latter is to treat all except patients at very low risk of complications. The proportion of patients with chronic hepatitis B who meet this strategy has risen from 10.3% to 26.5%~33.9%, but it is still far from the World Health Organization's proposed treatment target of 80%. Therefore, in an attempt to achieve the goal of eliminating hepatitis B by 2030, a "treat all" strategy has been proposed, wherein all chronic hepatitis B patients who test positive for HBV DNA should be treated as early as possible.