# Treat everyone with chronic hepatitis B to prevent liver cancer

Source: https://onco.cc/ideas/idea-prev-hbv-treat-all-hcc/  
OnCo record `idea-prev-hbv-treat-all-hcc` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Hepatitis B causes most liver cancer worldwide, and generic tenofovir suppresses it for under 30 dollars a year. Treating everyone infected, not just those with liver damage, as WHO's 2024 guidelines allow, would cut liver cancer incidence because viral load predicts it and antivirals reduce it in cirrhotics.

## Summary

Hepatitis B causes most liver cancer worldwide and cheap tablets suppress it, so this idea runs national test-and-treat-all programmes with simplified monitoring rather than restricting treatment to people with liver damage. WHO broadened treatment eligibility in its 2024 guidelines and generic tenofovir costs under 30 dollars a year; viral load predicts hepatocellular carcinoma in the REVEAL cohort and antivirals reduce it in cirrhotics, so treating everyone infected is logical and cheap. The outcome is hepatocellular carcinoma incidence in treated cohorts. The test is a stepped rollout in high-prevalence countries with registry linkage. Being tested at scale, it addresses the bottlenecks Prevention we already have is not deployed and Most of the world has almost no cancer care.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Treat-all reduces HCC incidence by at least half over ten years in treated adults compared with eligibility-restricted treatment.
- Rationale: Viral load predicts HCC (REVEAL cohort); antivirals reduce HCC in cirrhotics; extension to all is logical and cheap.
- Proposed test: Stepped rollout in high-prevalence countries with registry linkage and cost-effectiveness modelling.
- Maturity: being-tested-at-scale
- Actor: policy

## Sources

- WHO hepatitis B fact sheet: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b

## Connected records

- cancers: [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/)
- fronts: [Prevention & Risk](https://onco.cc/fronts/prevention/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/)
- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/)

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