There are two reasons why chronic hepatitis B is of concern to the entire community. One is that it is currently incurable. The other is because: if slow hepatitis B is not effectively treated, it will likely progress to cirrhosis or liver cancer. The prognosis of cirrhosis and liver cancer is poor and greatly affects the life expectancy and quality of life of patients. The annual incidence of cirrhosis in patients with chronic hepatitis B is about 2% to 10%, and risk factors include older age, male gender, persistently elevated ALT, HBV DNA >2,000
IU/mL, persistent HBeAg positivity, genotype C, co-morbid hepatitis C or AIDS, chronic alcohol consumption and obesity. Once cirrhosis develops, 3-5% of patients will develop complications such as ascites, upper gastrointestinal bleeding, and hepatic encephalopathy (also known as hepatic coma) each year. Patients with cirrhosis who develop complications are called decompensated cirrhosis. These patients have a 5-year survival rate of only 14% to 35% if their disease is not effectively controlled. This means that 60% of patients with slow hepatitis B who progress to decompensated cirrhosis will die every 5 years from complications of cirrhosis. The annual incidence of liver cancer in patients with slow hepatitis B who have not progressed to cirrhosis is 0.5% to 1.0%. In contrast, the annual incidence of hepatocellular carcinoma in patients with hepatitis B cirrhosis is as high as 3% to 6%. Early stage hepatocellular carcinoma is mostly asymptomatic and can be detected by regular examination. If it is less than 3cm in diameter when detected and is solitary, it can be radically treated by surgery. However, hepatocellular carcinoma is a malignant tumor with rapid progression. Once symptoms appear, the chance of eradication is lost. The average time from the appearance of symptoms to death is 3 to 6 months. In other words, the average survival time of advanced liver cancer is less than six months. Because slow hepatitis B cannot be cured and has the risk of progressing to cirrhosis and liver cancer; therefore, in response to these two poor prognoses, the goal of current treatment for slow hepatitis B is set to delay and reduce the occurrence of cirrhosis loss, liver cancer and other complications, thus improving quality of life and prolonging survival time.