If hepatitis B surface antigen is positive, have a liver ultrasound and alpha-fetoprotein every half year, let the doctor decide whether to take an antiviral, and do not stop it on your own once you start

People who carry hepatitis B virus, checked every half year with ultrasound and alpha-fetoprotein, had nearly 40% fewer deaths from liver cancer in a Shanghai trial. The more virus in the blood, the more liver cancer later. People whose liver was already badly fibrotic or cirrhotic, once on an antiviral, had about half as much liver cancer. Most of these drugs have to be taken long term; if you stop on your own the virus readily rebounds.

Cost

Go to hepatology or infectious disease every half year, have blood drawn, and have an ultrasound; the fee differs by place. If an antiviral is needed, the National Healthcare Security Administration (国家医保局) says that after pooled procurement the yearly cost of entecavir fell to a bit over 100 CNY. The hard part is going on time when you feel nothing, and staying on the drug.

Benefit

A randomized trial in Shanghai of 18816 people aged 35 to 59, all infected with hepatitis B virus or with a history of chronic hepatitis. The screening group was invited every 6 months for alpha-fetoprotein and ultrasound; the control group was not screened. Alpha-fetoprotein is a blood marker that often rises when liver cancer is present. Deaths from liver cancer were 32 in the screening group and 54 in the control group. Liver-cancer mortality was 83.2 versus 131.5 per 100000 people. The screening group was 0.63 times the control group (95% CI 0.41–0.98, confidence interval), about 37% lower. Of the liver cancers found in the screening group, 46.5% were surgically removed, against 7.5% in the control group. A follow-up study in Taiwan of 3653 people aged 30 to 65 who were surface-antigen positive, followed for a mean of 11.4 years, recorded only, not assigned to groups. The more virus in the blood at entry, the more liver cancer later. Below 300 copies per milliliter, there were 108 liver cancers per 100000 person-years. Above 1000000 copies per milliliter, there were 1152. The cumulative share who developed liver cancer was 1.3% and 14.9%. After accounting for sex, age, smoking, alcohol, aminotransferases, and cirrhosis, more virus still meant more liver cancer. An Asian randomized trial of 651 people with chronic hepatitis B who already had severe liver fibrosis or cirrhosis. A lamivudine group and a placebo group were followed for a median of 32.4 months. Liver cancer was 3.9% versus 7.4%, about half the risk (HR 0.49, P=0.047). Worsening of disease was 7.8% versus 17.7% (HR 0.45, about 55% lower). The 2022 guideline of the Chinese Medical Association (中华医学会) states that people with chronic hepatitis B virus infection should have an abdominal ultrasound and alpha-fetoprotein every 6 months to screen for liver cancer. People at high risk should have them at least every 3 to 6 months. Carriers who do not yet need drugs should have a blood count, liver function, viral markers, alpha-fetoprotein, and ultrasound every 6 to 12 months. Once the conditions for treatment are met, start at once. If virus is detectable in the blood, antiviral treatment is recommended after age 30, whether or not aminotransferases are high. The same applies if someone in the family developed cirrhosis or liver cancer from hepatitis B. The oral drugs the guideline recommends are the entecavir and tenofovir class. The guideline states that most people need long-term treatment, and that the share whose virus rebounds after stopping is high

Notes

Disputed: some people do not accept the conclusion of that Shanghai trial. A 2003 Cochrane review recalculated it by its own method. The difference in liver-cancer deaths was not significant (OR 0.81, 0.54–1.22). The 2012 update said the trial had a high risk of bias, the figures in the reports did not match, and no conclusion could be drawn. So "every half year" rests on this disputed trial, plus guidelines in various countries. Lamivudine is an old drug; in the trial 49% developed a resistance mutation, and guidelines now recommend the entecavir class. Whether to start, and whether stopping is possible, depends on viral load, aminotransferases, the degree of liver fibrosis, and family history, and the doctor decides. People not yet infected should have the hepatitis B panel (两对半) and the vaccine; see section 1, item 14 (hepatitis B panel). Hepatitis C is a different disease; see section 1, item 45 (hepatitis C antibody). Alcohol damages the liver; see section 2, item 19 (drink little or no alcohol). The person who benefits is mainly you.

Sources · 6

1. Zhang BH, Yang BH, Tang ZY (2004). Randomized controlled trial of screening for hepatocellular carcinoma. Journal of Cancer Research and Clinical Oncology, 130(7), 417-422. doi.org/10.1007/s00432-004-0552-0
2. Chen CJ, Yang HI, Su J, et al.; REVEAL-HBV Study Group (2006). Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA, 295(1), 65-73. doi.org/10.1001/jama.295.1.65
3. Liaw YF, Sung JJ, Chow WC, et al.; Cirrhosis Asian Lamivudine Multicentre Study Group (2004). Lamivudine for patients with chronic hepatitis B and advanced liver disease. New England Journal of Medicine, 351(15), 1521-1531. doi.org/10.1056/NEJMoa033364
4. 中华医学会肝病学分会, 中华医学会感染病学分会 (2022). 慢性乙型肝炎防治指南（2022 年版）. 中华肝脏病杂志, 30(12), 1309-1331. doi.org/10.3760/cma.j.cn501113-20221204-00607
5. 同一指南的英文版：You H, Wang F, Li T, et al. (2023). Guidelines for the Prevention and Treatment of Chronic Hepatitis B (version 2022). Journal of Clinical and Translational Hepatology, 11(6), 1425-1442. doi.org/10.14218/JCTH.2023.00320
6. Wun YT, Dickinson JA (2003). Alpha-fetoprotein and/or liver ultrasonography for liver cancer screening in patients with chronic hepatitis B. Cochrane Database of Systematic Reviews, CD002799. doi.org/10.1002/14651858.CD002799（反方）；Aghoram R, Cai P, Dickinson JA (2012). Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B. Cochrane Database of Systematic Reviews, CD002799.pub2. doi.org/10.1002/14651858.CD002799.pub2（反方）；国家医疗保障局 (2025). 中国医保惠民生 积跬步、至长远（七）：医药集采规范化制度化常态化：「乙肝治疗一线用药恩替卡韦，过去患者吃一年的费用大约5000元……集采后恩替卡韦年费用降到100多元」. nhsa.gov.cn/art/2025/12/29/art_14_19172.html