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

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. This Review provides an overview of the global epidemiology and burden of hepatitis B virus (HBV) infection, identifying gaps in the HBV care cascade and proposing some solutions to help reach the goal of WHO to eliminate HBV as a public health threat by 2030. 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 i