Verso una gestione personalizzata dei portatori di infezione cronica da HBV e dei pazienti affetti da epatocarcinoma

Chronic liver disease is characterized by a long-lasting, asymptomatic course, that in a proprotion of patients may evolve in liver cirrhosis that eventually leads to its end-stage complications including hepatocellular carcinoma (HCC). Therefore, an appropriate management of subjects at risk requires the timely identification and treatment of those with progressive liver disease. This holds true particularly for chronic hepatitis B surface antigen (HBsAg) carriers, because of the complex and multifaceted clinical expression of Hepatitis B virus (HBV) infection, which results from the dynamic interplay between virus and host’s immune system. Accordingly, even if only a minority of chronically infected individuals has chronic hepatitis B (CHB), their prompt identification and treatment is mandatory because of the high risk of progression to cirrhosis and HCC development. After almost seventy years from the first identification of the “Australia Antigen” and the consistent achievements of current antiviral therapy which in the one hand, suppressing HBV replication, warrants a cure of chronic hepatitis B and in the other hand provides the enormous results of eradicating hepatitis C virus infection (HCV), the World Health Organization set the ambitious commitment to eliminate viral hepatitis as a public health threat by 2030, reducing new infections by 90% and mortality by 65%. In addition, we are on the edge of a new era of drug development which is likely to increase the chances of a “functional cure” for chronic HBV infection, defined as durable HBsAg loss and undetectable serum HBV DNA after completing a course of treatment. In view of these challenging issues, there is an urgent need to refine the clinical management of HBV chronic carriers with patient-oriented strategies based upon the concepts of appropriateness and sustainability of care. The present thesis reports 3 original studies which addressed important issues for the personalized management of chronic HBsAg carriers and patients at HCC risk.