Liver diseases and hepatocellular carcinoma in the Asia-Pacific region: burden, trends, challenges and future directions

Abstract

Globally, nearly half of deaths from cirrhosis and chronic liver diseases (CLD) and three-quarters of deaths from hepatocellular carcinoma (HCC) occur in the Asia-Pacific region. Chronic hepatitis B is responsible for the vast majority of liver-related deaths in the region. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common form of CLD, affecting an estimated 30% of the adult population. Compared with people of European descent, people from the Asia-Pacific region carry more genetic variants associated with MASLD and its progression. Alcohol is a fast-growing cause of CLD and HCC in Asia as a result of the rising per-capita consumption of alcohol. Drug-induced liver injury is under-recognized and probably has a high prevalence in this region. The epidemiological and outcome data of acute-on-chronic liver failure are heterogeneous, and non-unified definitions across regions contribute to this heterogeneity. CLDs are severely underdiagnosed, and effective treatments and vaccinations are underutilized. In this Review, we highlight trends in the burden of CLD and HCC in the Asia-Pacific region and discuss the rapidly changing aetiologies of liver disease. We examine the multiple gaps in the care cascade and propose mitigating strategies and future directions. Mortality related to liver diseases and liver cancer is high and on the rise in the Asia-Pacific region. This Review summarizes the current epidemiological data and discusses the changing landscape of burden and aetiology of liver disease and liver cancer in the Asia-Pacific region. Over 50% of global deaths related to chronic liver disease, cirrhosis, and liver cancer occur in the Asia-Pacific region.The majority of people living with chronic hepatitis B (CHB) infection are undiagnosed or untreated, rendering CHB the key cause of liver-related deaths in the Asia-Pacific region.Differences in genetic makeup, lifestyle and cultures contribute to unique phenotypes of metabolic dysfunction-associated steatotic liver disease in the Asia-Pacific region.Many challenges in tackling chronic liver diseases in the Asia-Pacific region stem from resource limitations, leading to poor accessibility to investigations and treatments.Regulation of alcohol use, enforcement of national strategies for viral hepatitis elimination, and the establishment of pharmacovigilance programmes and disease awareness campaigns might reduce the burden of chronic liver disease in Asia.