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Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain significant public health challenges in Asia, affecting millions and contributing to substantial morbidity and mortality. The prevalence of these infections varies across the region, with factors such as vaccination coverage, healthcare infrastructure, and sociocultural barriers influencing the epidemiology of both viruses. The persistent burden of chronic HBV, particularly in older populations, and the evolving HCV genotype landscape highlight the need for targeted, region-specific strategies. Universal screening programs have emerged as essential tools for detecting undiagnosed cases and optimizing healthcare resource allocation. Given the overlapping epidemiology of HBV and HCV, comprehensive public health interventions tailored to the unique contexts of different Asian countries are crucial for achieving global elimination goals. This review examines the epidemiological trends, challenges, and opportunities for addressing HBV and HCV in Asia, emphasizing the importance of overcoming sociocultural barriers to improve prevention, diagnosis, and treatment efforts across diverse populations.

Chronic hepatitis B virus (HBV) infection remains a major global health burden and a leading cause of hepatocellular carcinoma (HCC). While cirrhosis is a well-established risk factor, the contributions of metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiometabolic risk factors (CMRFs) are less clearly defined. This study aimed to evaluate the impact of MASLD and CMRFs on HCC risk in patients with chronic hepatitis B (CHB). We conducted a retrospective cohort study of CHB patients at Songklanagarind Hospital between 2011 and 2021, excluding those diagnosed with HCC within six months of follow-up. Clinical and imaging data were analyzed. Cumulative HCC incidence was estimated using Nelson-Aalen plots. Multivariable Cox regression was used to identify independent predictors. The aMAP score was evaluated in subgroups with obesity, CMRFs, and MASLD. Among 4,944 patients, 151 (3.1%) developed HCC. Cirrhosis (adjusted hazard ratio [aHR] 7.22), obesity (aHR 1.85), and male sex (aHR 1.78) were independent risk factors. Statin use (aHR 0.43), higher platelet count (aHR 0.62), and higher albumin (aHR 0.64) were protective. Diabetes and hypertension showed nonsignificant trends, and steatosis and dyslipidemia without statins were not significantly associated with HCC. Risk increased with the number of CMRFs. The aMAP score showed good discrimination in patients with obesity (C-index 0.82), CMRFs (0.79), MASLD (0.74), and in the non-cirrhotic MASLD and non-MASLD (0.69 and 0.71, respectively). Cirrhosis, male sex, and obesity were key HCC risk factors. The aMAP score effectively stratified HCC risk among metabolically at-risk CHB patients.

Tenofovir alafenamide (TAF) is recommended for chronic hepatitis B (CHB) treatment in international guidelines according to its efficacy and safety. However, in phase III study, an increased LDL-c was observed in those who were switched from Tenofovir disoproxil fumarate (TDF) to TAF. Limited data exists on whether lipid profiles change only in individuals who switched to TAF from TDF or from any nucleoside/nucleotide analogues (NUC). We investigated how switching to TAF affected lipid and cardiovascular outcomes in Thai CHB patients. We conducted a prospective observational study including CHB patients who had to switch from their prior NUC to TAF according to the national reimbursement policy in late 2022. All enrolled patients had lipid tests and transient elastography (TE) done at 0 and 48-week post-switch to TAF. Demographic data, prior NUC, liver biochemistry, controlled attenuated parameter (CAP) and liver stiffness (elastic modulus; E) data measured by TE were collected. The changes in lipid, Thai cardiovascular (CV) risk score, and TE results between 0 and 48-week were compared. A total of 110 patients who were switched to TAF and completed 48-week follow-up were analyzed. The prior NUCs were as follows: 47 Lamivudine (LAM), 22 Entecavir (ETV), and 41 TDF-based. Baseline characteristics were similar between the three groups except for underlying hypertension was more frequent and baseline total cholesterol was lower in the TDF-based group. At 48-week post-switch, the median LDL-c changes were -2.45, -5.9 and +8.8 mg/dL (p<0.001), and total cholesterol changes were -4.5, -4 and +17 mg/dL (p<0.001), in the ETV, LAM, and TDF-based group, respectively. Whereas the changes in hepatic steatosis (measured by CAP), and liver stiffness (measured by E) as well as Thai CV risk score were not significantly different. No cardiovascular events occurred during follow-up. Significant increase in LDL-c and total cholesterol after switching to TAF were observed only in patients with prior TDF, but not in those with prior ETV or LAM. Careful monitoring of lipids after the switch may not be universally needed. Data regarding long-term cardiovascular outcomes are warrant.

Chronic liver disease (CLD) is a major global public health challenge due to its high morbidity and mortality. In Thailand, the burden of CLD remains underexplored despite its significant impact on healthcare systems. This study examines trends in hospitalizations, etiologies, and in-hospital mortality associated with CLD, including cirrhosis and hepatocellular carcinoma (HCC), from 2017 to 2022. We conducted a nationwide, population-based, cross-sectional time-series study using inpatient claims data from the National Health Security Office (NHSO) in Thailand. Data from fiscal years 2016 to 2022 were analyzed, focusing on CLD-related hospitalizations categorized by etiology using ICD-10 codes. Age- and sex-standardized incidence and mortality rates were assessed through descriptive and trend analyses, with LOESS smoothing applied to identify temporal patterns. Between 2017 and 2022, 119,464 hospitalizations for CLD were recorded, with 77% of patients being male and a median age of 45–66 years. Alcohol-associated liver disease was the leading cause (30.8%), followed by chronic hepatitis B (11.3%), hepatitis C (10.3%), and metabolic dysfunction-associated steatotic liver disease (MASLD, 9.6%). Etiology was unidentified in 37.5% of cases. Cirrhosis accounted for most hospitalizations, with a stable incidence of 1200–1600 cases per month. Alcohol-associated cirrhosis was the most prevalent, while MASLD-related cirrhosis had the highest mortality. Age-standardized mortality rates for hepatitis B- and C-related cirrhosis declined over the study period. HCC incidence remained stable, with hepatitis B, hepatitis C, and MASLD contributing 23, 16, and 8 cases per 10 million population per month, respectively. By 2022, MASLD-related HCC mortality had surpassed alcohol-related causes. CLD remains a major health burden in Thailand, with high mortality driven by viral hepatitis, alcohol consumption, and MASLD. Strengthening prevention strategies, early diagnosis, and equitable access to effective therapies is essential. Enhanced public health interventions and ongoing surveillance are critical to mitigating the growing CLD burden.

Primary liver cancer is the third leading cause of cancer-related mortality. The increasing prevalence of metabolic syndrome and alcohol consumption, along with the existing burden of viral hepatitis, could significantly heighten the impact of primary liver cancer. However, the specific effects of these factors in the Asia–Pacific region, which comprises more than half of the global population, remain largely unexplored. This study aims to analyze the epidemiology of primary liver cancer in the Asia–Pacific region. We evaluated regional and national data from the Global Burden of Disease study spanning 2010 to 2019 to assess the age-standardized incidence, mortality, and disability-adjusted life years associated with primary liver cancer in the Asia–Pacific region. During the study period, there were an estimated 364,700 new cases of primary liver cancer and 324,100 deaths, accounting for 68 and 67% of the global totals, respectively. Upward trends were observed in the age-standardized incidence rates of primary liver cancer due to metabolic dysfunction-associated fatty liver disease (MASLD) and alcohol-associated liver disease (ALD) in the Asia–Pacific region, as well as an increase in primary liver cancer from Hepatitis B virus infection in the Western Pacific region. Notably, approximately 17% of new cases occurred in individuals aged 15–49 years. Despite an overall decline in the burden of primary liver cancer in the Asia–Pacific region over the past decade, increases in incidence were noted for several etiologies, including MASLD and ALD. However, viral hepatitis remains the leading cause, responsible for over 60% of the total burden. These findings underscore the urgent need for comprehensive strategies to address the rising burden of primary liver cancer in the Asia–Pacific region.

Background Sarcopenia is associated with disability, mortality, and poorer survival in cirrhotic patients. For the evaluation of muscle volume, computed tomography (CT) is the most accurate tool. Unfortunately, it would be hard to apply a muscle mass measuring CT to daily practice. This research aims to study the utility of handgrip strength (HGS) and bioelectrical impedance analysis (BIA) to detect sarcopenia in cirrhotic patients compared with CT as the reference. Methods In cirrhotic patients who met inclusions criteria (age 20–70 years, ascites < grade 2 of International Ascites Club grading system, no active malignancy, and no cardiac implanted device), HGS were measured using a Jamar dynamometer. Subsequently, patients with low muscle strength (defined as JSH criteria, < 26 kg in male, < 18 kg in female) were then underwent CT and BIA (Tanita MC780 MA) on the same day to measure muscle volume, the definition of sarcopenia by CT was according to the Japan Society of Hepatology (JSH). We also collected data from patients with normal HGS whose CT results were available in the study period. Results From 146 cirrhotic patients who underwent HGS, 30 patients (20.5%) had diagnosed low HSG. Data from 50 patients whose available CT results included 30 low HGS and 20 patients with normal HSG. The HGS was strongly correlated with skeleton muscle index (SMI) by CT (r = 0.81, p  < 0.001) and had an excellent diagnostic performance for detecting sarcopenia by using JSH criteria the sensitivity, specificity, NPV and PPV were 88.2%, 100%, 100%, and 98.7% respectively. In contrast, only 6 of 30 patients (20%) met sarcopenic criteria by BIA. Among sarcopenic patients, the result showed a fair correlation between SMI and BIA (r = 0.54; p  < 0.002). Conclusion Our study demonstrated an excellent correlation between HGS and SMI by CT in the mixed cirrhotic population from the sarcopenia and non-sarcopenia groups. The HGS using the JSH criteria showed an excellent performance in detecting sarcopenia compared to CT. Nonetheless, for the BIA by using the current cut-offs demonstrated unacceptable rate to detect sarcopenia.

Background Capsule endoscopy (CE) is the preferred diagnostic test of choice in the investigation of obscure gastrointestinal bleeding (OGIB). Although, a conservative strategy is recommended in the short-term, for cases with a negative result from CE, the impact of CE on long-term re-bleeding still remains unclear. Hence, the aim of this study was to determine the long-term re-bleeding rate along with predictors after CE in patients with OGIB. Methods We retrospectively reviewed 216 patients with OGIB, whom had received a CE examination, so as to investigate the cause of obscure GI bleeding; between July 2008 and March 2018. The patient’s characteristics, medication use, CE finding, treatments strategy, re-bleeding episodes and follow-up information were collected from the institutional electronic medical chart and CE database. Re-bleeding free survival was evaluated using Kaplan-Meier curves with log rank test, whilst predictors associated with the re-bleeding episodes were analyzed via the use of Cox proportional hazard model. Results One hundred and thirty-three patients with OGIB, having received CE were enrolled in the analysis. The pool rate of re-bleeding was 26.3% (35/133) during a follow-up duration of 26 months after CE. Patients with positive CE study, without specific treatment, had higher rates of re-bleeding (47.6%) than those with positive study whom received specific treatment (25.7%), and negative study (20.8%) ( p  = 0.042). Although, the re-bleeding free survival was not significantly different among the groups (log rank test; P  = 0.10). Re-bleeding events occurring within 6, 12, and 24 months after CE were 36, 64 and 92%, respectively. The high-frequency re-bleeding etiologies were the small bowel angiodysplasias and abnormal vascular lesions. Furthermore, independent predictors for re-bleeding after CE were patients with cirrhosis (hazard ratio, HR 4.06), incomplete CE visualization (HR 2.97), and a history of previous GI bleeding (HR 2.80). Conclusions The likelihood of re-bleeding after CE was higher in patients with positive CE study than those with negative study. Specific treatments, or therapeutic interventions for patients with detectable lesions reduced the probability of re-bleeding episodes in long-term follow-up. Close follow-up for recurrent bleeding is recommeded for at least 2 years after CE.

We aimed to determine the relationship between the safety margin of an embolized area and local tumor recurrence (LTR) of patients with hepatocellular carcinoma (HCC) who underwent superselective transarterial chemoembolization (TACE). The medical records of 77 HCC patients with 109 HCC nodules who underwent superselective TACE were retrospectively analyzed for LTR. Univariate and multivariate analyses were performed for 16 potential factors using Cox proportional hazard regression. Iodized oil deposition on cone-beam computed tomography (CBCT) imaging was divided into three grades: A=complete tumor staining and complete circumferential safety margin, B=complete tumor staining but incomplete safety margin, C=incomplete tumor staining. The effect of a safety margin on LTR was evaluated by comparison between grade A and B group. Univariate and multivariate analyses revealed that grade A iodized oil deposition and portal vein visualization were the only two independent significant factors of LTR (P<0.001 and P=0.029, respectively). The 12- and 24-month LTR rates of tumors for grade A (n=62), grade B (n=30), and grade C (n=17) were 16% vs. 41% vs. 100% and 16% vs. 61% vs. 100%, respectively (P<0.001). The tumors in the grade A group had a 75% risk reduction in LTR (odds ratio, 0.25; 95% confidence interval, 0.10 to 0.64; P=0.004) compared to the grade B group. LTR was significantly lower when a greater degree of iodized oil deposition occurred with a complete circumferential safety margin. In superselective TACE, the safety margin of the embolized areas using intraprocedural CBCT affected LTR in HCC patients.

Cirrhosis patients with worsening of the liver function are defined as acute decompensation (AD) and those who develop extrahepatic organ failure are defined as acute-on-chronic liver failure (ACLF). Both AD and ACLF have an extremely poor prognosis. However, information regarding prognostic predictors is still lacking in Asian populations. We aimed to identify prognostic factors for 30-day and 90-day mortality in cirrhosis patients who develop AD with or without ACLF. We included 9 tertiary hospitals from Thailand in a retrospective observational study enrolling hospitalized cirrhosis patients with AD. ACLF was diagnosed according to the EASL-CLIF criteria, which defined as AD patients who have kidney failure or a combination of at least two non-kidney organ failure. Outcomes were clinical parameters and prognostic scores associated with mortality evaluated at 30 days and 90 days. Between 2015 and 2020, 602 patients (301 for each group) were included. The 30-day and 90-day mortality rates of ACLF vs. AD were 57.48% vs. 25.50% (p<0.001) and 67.44% vs. 32.78% (p<0.001), respectively. For ACLF patients, logistic regression analysis adjusted for demographic data, and clinical information showed that increasing creatinine was a predictor for 30-day mortality (p = 0.038), while the CLIF-C OF score predicted both 30-day (p = 0.018) and 90-day (p = 0.037) mortalities, achieving the best discriminatory power with AUROCs of 0.705 and 0.709, respectively. For AD patients, none of the parameters was found to be significantly associated with 30-day mortality, while bacterial infection, CLIF-AD score and Child-Turcotte-Pugh score were independent parameters associated with 90-day mortality, with p values of 0.041, 0.024 and 0.024. However, their predictive performance became nonsignificant after adjustment by multivariate regression analysis. Regarding Thai patients, the CLIF-C OF score was the best predictor for 30-day and 90-day mortalities in ACLF patients, while appropriate prognostic factors for AD patients remained inconclusive.

Large volume of new data on the natural history and treatment of chronic hepatitis B virus (HBV) infection have become available since 2008. These include further studies in asymptomatic subjects with chronic HBV infection and community-based cohorts, the role of HBV genotype/naturally occurring HBV mutations, the application of non-invasive assessment of hepatic fibrosis and quantitation of HBV surface antigen and new drug or new strategies towards more effective therapy. To update HBV management guidelines, relevant new data were reviewed and assessed by experts from the region, and the significance of the reported findings was discussed and debated. The earlier “Asian-Pacific consensus statement on the management of chronic hepatitis B” was revised accordingly. The key terms used in the statement were also defined. The new guidelines include general management, indications for fibrosis assessment, time to start or stop drug therapy, choice of drug to initiate therapy, when and how to monitor the patients during and after stopping drug therapy. Recommendations on the therapy of patients in special circumstances, including women in childbearing age, patients with antiviral drug resistance, concurrent viral infection, hepatic decompensation, patients receiving immune suppression or chemotherapy and patients in the setting of liver transplantation and hepatocellular carcinoma, are also included.