ABSTRACT
Hepatitis B virus (HBV) infection is a global health problem that affects almost one-third of the world’s population on the basis of serologic evidence of past or present infection. Nearly 360–400 million people have chronic HBV infection. Of these, 15–40% develop cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC) during their lifetime. HBV is a leading risk factor for HCC, with more than 80% of HCC cases occurring in regions that are also endemic for hepatitis B. Chronic HBV infection acquired in adults has a much lower risk of HCC development than infections resulting from early life transmission, possibly reflecting differences in duration of infection. HBV exerts its oncogenic potential through a multifactorial process that includes direct and indirect mechanisms that likely act synergistically. The risk scores for development of HCC in chronic HBV-infected patients can also provide guidance about treatment, particularly in patients who do not meet existing treatment initiation recommendations according to current treatment guidelines.
