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

Table 8 Pros and cons of expanded hepatitis B treatment in different regions of the world

Region/Country	Pros of expanded HBV treatment	Cons of expanded HBV treatment	Ref.
United States and Western Europe	Reduces liver cancer (HCC) and cirrhosis risk significantly. Cost-effective long-term due to lower healthcare costs of managing advanced liver disease. High-quality healthcare infrastructure for treatment. National vaccination programs decrease new infections	High upfront costs of expanding treatment programs. A complex treatment regimen requires continuous monitoring. Antiviral drug resistance can develop. Socioeconomic disparities affect access to treatment	[83,84]
Sub-Saharan Africa	Potential to reduce high hepatitis B prevalence (8%-12% in some regions). Cost-effective in preventing liver disease. Availability of generic drugs makes treatment affordable. Could prevent mother-to-child transmission	Limited healthcare infrastructure. Poor access to diagnostic tools. Healthcare worker shortages. High upfront costs for government to scale up treatment	[85-87]
China	A large reduction in liver cancer cases due to high HBV burden. Government-subsidized treatments improve access. An effective nationwide vaccination program	High cost of treating millions of chronic HBV patients. Disparities between urban and rural healthcare access. Drug adherence and monitoring are challenging in rural areas	[88,89]
India	Reduces HBV-related mortality in a country with significant disease burden. Affordable generic antivirals are available. National initiatives to improve vaccination rates and awareness	Limited healthcare infrastructure in rural areas. Low awareness about the need for regular treatment. Cultural stigma around liver disease may hinder uptake	[51]
South-East Asia (Vietnam, Thailand)	High impact due to large HBV burden in the region. Government-funded programs and access to generics lower costs. Reduction in liver cancer and other liver-related mortality	Treatment access is limited in rural and underserved areas - Monitoring and follow-up systems are underdeveloped. High costs of diagnostic tests in some areas	[90]
Eastern Europe and Russia	Potential to reduce the growing HBV burden. Generic antivirals are available at lower costs. Could lower healthcare costs related to advanced liver disease	Insufficient healthcare infrastructure in rural areas. Limited access to quality diagnostic and monitoring tools. Economic constraints hinder government spending on healthcare	[91]
Latin America (Brazil, Argentina)	Moderate HBV prevalence with opportunity for significant impact through expanded treatment. National vaccination programs are already in place. Availability of affordable drugs	Poor healthcare infrastructure in rural areas. Budgetary constraints limit widespread access to treatment. Socioeconomic disparities affect access	[92]
Middle East (Egypt, Iran)	High impact potential due to significant HBV burden. Availability of affordable generic treatments. Could reduce complications related to liver disease	Limited diagnostic infrastructure in rural regions. Cultural and religious beliefs may affect treatment adherence. Healthcare costs are a significant burden on government budgets	[93]

HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus.