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  • Review Article
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Global burden of hepatitis B virus: current status, missed opportunities and a call for action

Nature Reviews Gastroenterology & Hepatology volume 20, pages 524–537 (2023)Cite this article

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Abstract

Chronic hepatitis B virus (HBV) infection affects about 296 million people worldwide and is the leading aetiology of cirrhosis and liver cancer globally. Major medical complications also include acute flares and extrahepatic manifestations. In addition, people living with HBV infection also experience stigma. HBV-related cirrhosis resulted in an estimated 331,000 deaths in 2019, and it is estimated that the number of deaths from HBV-related liver cancer in 2019 was 192,000, an increase from 156,000 in 2010. Meanwhile, HBV remains severely underdiagnosed and effective measures that can prevent infection and disease progression are underutilized. Birth dose coverage for HBV vaccines remains low, particularly in low-income countries or regions where HBV burden is high. Patients with HBV infection are inadequately evaluated and linked to care and are undertreated worldwide, even in high-income countries or regions. Despite the goal of the World Health Organization to eliminate viral hepatitis as a public health problem by 2030, the annual global deaths from HBV are projected to increase by 39% from 2015 to 2030 if the status quo remains. In this Review, we discuss the current status and future projections of the global burden of HBV infection. We also discuss gaps in the current care cascade and propose future directions.

Key points

  • Globally, approximately 296 million people are currently living with hepatitis B virus (HBV), and the burden disproportionately affects sub-Saharan Africa and East Asia.

  • Substantial disparities in HBV burden exist not only between countries and regions but also within a country or region, with disparities by state or province, income, race or ethnicity, and other social and cultural factors.

  • Cirrhosis and liver cancer account for most HBV-related deaths, with acute flares and reactivation, extrahepatic complications, and social stigma further contributing to the burden of HBV.

  • Universal infant vaccination with timely birth dose and peripartum antiviral prophylaxis in mothers with a high level of HBV DNA can effectively prevent mother-to-child transmission, but these are currently underutilized.

  • Underdiagnosis and low treatment rates of chronic HBV infection are serious even in high-income countries or regions and are exacerbated in low-income countries or regions.

  • Prompt action is needed to remove the barriers that disrupt the current HBV care cascade and to close the gaps in HBV prevention, screening, diagnosis, linkage to care, antiviral treatment and liver cancer surveillance.

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Fig. 1: Global distribution of age-standardized death rates for cirrhosis and liver cancer attributed to HBV.
Fig. 2: The care cascade of HBV infection and the current gaps.

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Acknowledgements

The authors are grateful to the GBD study group that made data freely available. There was no funding for this article.

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Authors and Affiliations

  1. Center for Liver Diseases, E-Da Hospital, Kaohsiung, Taiwan

    Yao-Chun Hsu

  2. School of Medicine, I-Shou University, Kaohsiung, Taiwan

    Yao-Chun Hsu

  3. Division of Gastroenterology, Fu-Jen Catholic University Hospital, New Taipei, Taiwan

    Yao-Chun Hsu

  4. Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, New Taipei, Taiwan

    Yao-Chun Hsu

  5. Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore

    Daniel Q. Huang

  6. Department of Medicine, National University of Singapore, Singapore, Singapore

    Daniel Q. Huang

  7. Department of Medicine, Stanford University Medical Centre, Palo Alto, CA, USA

    Mindie H. Nguyen

  8. Department of Epidemiology and Population Health, Stanford University Medical Centre, Palo Alto, CA, USA

    Mindie H. Nguyen

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Y.-C.H. made a substantial contribution to the discussion of content, wrote the article and reviewed/edited the manuscript before submission. D.Q.H. researched data for the article and made a substantial contribution to the discussion of content. M.H.N. made a substantial contribution to the discussion of content and reviewed/edited the manuscript before submission.

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Competing interests

Y.-C.H. has received research support from Gilead Sciences, has served as an advisory board member for Gilead Sciences, and has received payments for lectures from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Merck Sharp & Dohme, and Novartis. D.Q.H. has served as a consultant for Eisai. M.H.N. has received research support from Pfizer, Gilead Sciences, Enanta, Vir Biotech, Glycotests, Exact Science, Helio Health, B. K. Kee Foundation, and the National Cancer Institute and has served as an advisory board member or consultant for Gilead, GSK, Intercept, Novartis, Eisai, Bayer, Exact Science, Laboratory of Advanced Medicine, Spring Bank, and Janssen.

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Hsu, YC., Huang, D.Q. & Nguyen, M.H. Global burden of hepatitis B virus: current status, missed opportunities and a call for action. Nat Rev Gastroenterol Hepatol 20, 524–537 (2023). https://doi.org/10.1038/s41575-023-00760-9

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