Review article: immunisation against hepatitis B virus infection and the prevention of hepatocellular carcinoma

Summary Background Chronic hepatitis B virus (HBV) infection results in a high risk of cirrhosis and its complications: cirrhosis decompensation, hepatocellular carcinoma (HCC, the fourth most common cause of cancer‐related mortality worldwide), liver transplantation and death. It is now 40 years since development of the first plasmatic vaccine which has been proven to prevent (liver) cancer. Aims To update firstly the molecular and epidemiological aspects of HBV‐related HCC and its natural history together with the benefits associated with viral suppression and secondly the safety, immunogenicity and efficacy of HBV vaccination. Methods Analysis of recent published data regarding HBV replication, anti‐viral treatments and vaccination. Results The nuclear HBV replication cycle in the hepatocyte combines two limiting steps to achievement of HBV cure during chronic infection: the formation of a minichromosome, the supercoiled cccDNA, and host‐genome integration of HBV DNA which triggers direct viral hepatocarcinogenesis. Even if specific anti‐viral treatments significantly reduce viral replication, they decrease but do not cancel the risk of liver‐related events in contrast with the prevention of HBV through HBV vaccination. Conclusions To achieve the 2030 viral hepatitis elimination plan, the HBV vaccine is a priority tool for achieving the sustainable development goals of the World Health Organization.