Chronic Hepatitis B: China's 2022 Prevention and Treatment Guideline
Around 70 million people in China live with chronic HBV. The 2022 guideline explains the phases of infection, why cccDNA makes cure difficult, how transmission is blocked, and who should be treated.
Chronic hepatitis B is a long-term liver inflammation caused by persistent infection with the hepatitis B virus. Globally some 296 million people are chronically infected and around 820,000 deaths a year are attributed to HBV-related cirrhosis, liver failure and hepatocellular carcinoma. China has made enormous progress - childhood vaccination has cut HBsAg prevalence in young children from around 10 percent to well under 1 percent - but the absolute burden remains large, with an estimated 70 million chronic carriers.
The 2022 Chinese guideline on prevention and treatment of chronic hepatitis B, issued by the Chinese Society of Hepatology and the Chinese Society of Infectious Diseases, updates the 2019 edition.
The virus
Ten genotypes, A through J, are described. China is dominated by genotypes B and C, with C more common in the north and carrying a higher risk of cirrhosis and cancer. Because the viral polymerase lacks proofreading ability, variants arise readily - including precore and basal core promoter mutants that produce HBeAg-negative disease, and polymerase mutants that confer drug resistance.
Why it becomes chronic
Transmission
The phases of chronic infection
Immune tolerance: HBsAg positive, HBeAg positive, very high HBV DNA, normal ALT, minimal histological activity - typical of perinatally acquired infection and lasting for decades.
Immune clearance, or HBeAg-positive chronic hepatitis: ALT rises, HBV DNA falls somewhat, and histology shows moderate to severe inflammation with faster fibrosis progression. HBeAg seroconversion may occur here.
Inactive carrier state: HBeAg negative with anti-HBe positive, low or undetectable DNA, persistently normal ALT, and minimal activity. Risk is lower but not zero.
Reactivation, or HBeAg-negative chronic hepatitis: driven by precore or basal core promoter variants, with fluctuating ALT and DNA and ongoing fibrosis risk.
