{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:48:56Z","timestamp":1792043336397,"version":"4.4.0"},"reference-count":36,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Antiviral therapy with nucleos(t)ide analogues is recommended for patients with viremic hepatitis B virus (HBV)\u2010related cirrhosis regardless of levels of viremia or liver enzymes. However, hepatocellular carcinoma (HCC) is not an antiviral treatment criterion in the U.S. HBV treatment guidelines, though prior studies have reported improved survival with antiviral treatment in HBV\u2010related HCC. To inform guidelines, we estimated antiviral treatment rates and their association with survival and HCC recurrence rates in HBV\u2010related HCC. We conducted a systematic review and meta\u2010analysis of studies published between 2006 and 2024 that reported antiviral treatment, survival, and\/or HCC recurrence rates in adults with HBV\u2010related HCC, following PRISMA guidelines. Random\u2010effects models pooled study estimates. Of the initial 4556 studies, 178 underwent full\u2010text review, and 78 (68,243 patients) were analysed. The pooled antiviral treatment rate (52 studies, 41,345 patients) was 53.1%. In studies reporting pre\u2010HCC antiviral initiation, 17.2% of HBV\u2010related HCC patients received therapy before diagnosis. Treated (vs untreated) patients had higher 3\u2010 and 5\u2010year OS (80.4% vs. 59.2% and 72.1% vs. 46.8%, both\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). Five\u2010year OS was 78.0% vs. 56.4% in inactive HCC (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01) and 48.2% vs. 22.6% in active HCC (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.14). Antiviral therapy remained independently associated with improved 5\u2010year OS in multivariable meta\u2010regression. There was no significant difference in HCC recurrence rates. Antiviral therapy is associated with improved long\u2010term survival but remains underutilized in HBV\u2010related HCC. These findings highlight a critical gap in care and underscore the need for earlier and more consistent antiviral initiation in patients with HBV\u2010related HCC.\n                  <\/jats:p>","DOI":"10.1111\/jvh.70245","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:32:20Z","timestamp":1792042340000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Global Underutilization of Antiviral Therapy and Survival Outcomes in Hepatitis B Virus\u2010Related Hepatocellular Carcinoma: A Systematic Review and Meta\u2010Analysis of 78 Studies and 68,243 Patients"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7754-3757","authenticated-orcid":false,"given":"Sahith","family":"Kudaravalli","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University Medical Center  Palo Alto California USA"},{"name":"University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taotao","family":"Yan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University Medical Center  Palo Alto California USA"},{"name":"Department of Infectious Diseases The First Affiliated Hospital of Xi'an Jiaotong University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4507-2414","authenticated-orcid":false,"given":"Cheng\u2010Hao","family":"Tseng","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine E\u2010Da Cancer Hospital\/I\u2010Shou University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8984-5103","authenticated-orcid":false,"given":"Yao\u2010Chun","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Medical Research, School of Medicine Fu Jen Catholic University  New Taipei City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohe","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University Medical Center  Palo Alto California USA"},{"name":"Division of Infectious Disease The Third People's Hospital of Shenzhen  Shenzhen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuankai","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Third Affiliated Hospital of Sun Yat\u2010Sen University  Guangzhou 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