Korean researchers have found that treatment for hepatitis B should be initiated based on viral loads, not liver somatic index, to lower the risk of hepatocellular carcinoma (HCC) effectively.

Asan Medical Center said Tuesday that its research team, led by Professors Lim Young-suk and Choi Won-mook of the Department of Gastroenterology followed 9,709 adult patients with chronic hepatitis B for several years to determine their risk of developing HCC.

The researchers followed 4,693 adults who started treatment for hepatitis B at five Korean hospitals -- Asan Medical Center, Kyung Hee University Medical Center, Samsung Medical Center, Seoul National University Hospital, and Seoul National University Bundang Hospital -- for an average of 7.6 years and 193 of them developed HCC.

In contrast, among the 5,016 patients who did not receive hepatitis treatment, 322 developed HCC. This suggests that hepatitis treatment reduces the risk of developing HCC by about 50 percent overall.

However, in both the treated and untreated groups, the risk of liver cancer was highest when the viral load was 1 million units per milliliter of blood (6 log10 IU/mL). In contrast, as viral loads moved away from 1 million units, or, in other words, patients with very low (less than 10,000 units) or very high (100 million units and more, ≥8 log10 IU/mL) showed the lowest risk of developing hepatitis cancer.

Taken together, the risk of developing liver cancer was up to 6.1 times higher in untreated patients with viral loads above 100 million units compared to those who started treatment at 1 million units.

Previously, it was thought that the risk of liver cancer increased linearly with viral loads, which were not associated with the risk of liver cancer once treatment for hepatitis was initiated.

However, the researchers concluded that it is best to start hepatitis treatment when viral loads are very high (>100 million units, ≥8 log10 IU/mL) or fairly low (<10,000 units) to prevent liver cancer maximally.

The bottom line is that to keep the risk of liver cancer low, the complex criteria for initiating hepatitis B treatment should be simplified to blood viral loads alone, and treatment should be started earlier, they emphasized.

The current health insurance coverage criteria for hepatitis B treatment are very complex. It requires viral loads of at least 2,000 units and a liver level (AST or ALT) of at least twice the upper limit of normal (80 IU/L).

"Every year, about 12,000 new cases of liver cancer are diagnosed in Korea, mostly middle-aged men, causing serious socioeconomic losses and family crises," Professor Lim said. "Health insurance coverage standards should be revised to allow adult patients with hepatitis B virus load of 2,000 IU/mL or higher to start hepatitis treatment immediately, regardless of their liver load. This could prevent about 3,000 liver cancer cases a year and about 40,000 over the next 15 years."

It is also already proven that simplifying and accelerating the timing of hepatitis B treatment based on hepatitis virus load will reduce the cost burden on society by preventing the development of liver cancer, Lim added.

The findings were recently published in the online edition of GUT (impact factor of 24.5), the world's most prestigious journal in gastroenterology. The study is expected to have a significant impact on the revision of domestic and international hepatitis B treatment guidelines and health insurance benefit standards, the hospital said.