In Taiwan, hepatitis B remains a major public health concern. More than 1.8 million Taiwanese are living with chronic infection, a condition that plays a central role in the development of liver cancer and is the second leading cause of cancer-related death. Around 8,000 people die from liver cancer each year, and about 70% of liver cancer patients in Taiwan have a history of hepatitis B.

Although advances such as universal vaccination have significantly reduced the incidence of the disease over recent decades, efforts to achieve further progress continue.

Dr. Kao Jia-horng, vice superintendent of National Taiwan University Hospital and president of the Gastroenterological Society of Taiwan, stresses the importance of controlling hepatitis B in decreasing liver cancer incidence and mortality.

“Historically, hepatitis B accounted for as much as 80% of chronic liver disease cases and liver cancer in Taiwan,” says Dr. Kao. “While that proportion has declined due to vaccination and treatment efforts, hepatitis B remains responsible for roughly half of liver cancer cases, with hepatitis C and metabolic-related conditions comprising the remainder.”

Advances in clinical practice are enabling more precise management of hepatitis B, particularly in identifying patients at different levels of risk and enabling earlier treatment for those at higher risk — an approach shown to lower liver cancer incidence and increase the likelihood of bringing the virus under control to the point where it is no longer active.

“By integrating indicators such as viral load, liver fibrosis stage, and hepatitis B surface antigen levels, clinicians can now categorize patients into low-, intermediate-, and high-risk groups for disease progression and liver cancer,” Dr. Kao says. “This structure allows for more tailored screening intervals and earlier initiation of treatment for those at highest risk.”

While existing antiviral therapies are effective in suppressing viral replication, they rarely achieve what clinicians define as a “functional cure” — meaning the elimination of hepatitis B surface antigens (HBsAg), the key goal in hepatitis B treatment.

Dr. Kao notes that “patients who reach functional cure can see their risk of liver cancer decline dramatically — from as high as 80% in those with persistent viral activity to around 4%. However, current therapies achieve functional cure in fewer than 3% of patients even after long-term treatment.” A growing pipeline of therapies under development is showing promising progress, with the potential to improve patient outcomes and move closer to making a functional cure more achievable.

Efforts are also underway to refine treatment approaches and expand access to care. Recent updates to international treatment guidelines emphasize earlier intervention and broader eligibility, prompting discussion around how Taiwan’s policies can more closely align with global standards. As Dr. Kao notes, treatment decisions should be guided by factors such as liver enzyme levels, viral load, and the extent of liver damage, enabling more patients to access timely care.

Gaps in screening coverage continue to limit early identification of hepatitis B cases, namely among populations born before the introduction of universal vaccination in 1986. Although nationwide programs are in place, broader uptake and sustained public awareness are needed to identify undiagnosed patients and link them to care earlier in the course of the disease.

At the same time, ensuring continuity of care remains a critical challenge, especially in ensuring long-term monitoring to ensure adherence to treatment. As Dr. Kao emphasizes, maintaining a strong doctor–patient relationship and helping patients clearly understand the benefits of follow-up and treatment are essential to keeping them engaged in long-term care.

Taiwan’s experience with hepatitis C offers a model for what coordinated policy and sustained investment can achieve. Since the introduction of direct-acting antivirals in 2017, Taiwan has treated more than 90% of diagnosed hepatitis C patients, placing it among global leaders in elimination efforts. One of the key factors behind this progress has been the early adoption of innovative therapies. As Taiwan prepares to apply for hepatitis C elimination certification and moves toward the WHO’s 2030 hepatitis elimination targets, this momentum can be used to drive a stronger policy focus on hepatitis B, including ensuring timely access to new treatment. Increased government attention, clearer policy planning, and sustained funding allocation will be critical, Dr. Kao says.

Sponsored by GSK.