The impacts on liver health from a unique strain of chronic hepatitis B, which predominantly affects First Nations people, have been revealed in a study.
Analysing the C4 hepatitis B strain among Aboriginal and Torres Strait Islander people, researchers from Menzies School of Health Research found a severe type of liver disease among those living with the infection.
"The things we worry about when people have hepatitis B as a chronic infection, if they get liver damage, which can progress to liver cirrhosis or liver failure, and they are also at higher risk of liver cancer," study lead and Menzies Hepatitis B program lead Jane Davies told AAP.
"This C4 sub-genotype, when we looked at it in the lab at the very detailed genetics of it, it looked like it was very aggressive with respect to these two things."
The study confirmed the lab findings by analysing clinical data from more than 780 people across the Northern Territory, Professor Davies said.
She said 22 per cent of people in this cohort had significant liver damage, and 16 per cent of those had cirrhosis, which is severe scarring on the liver, which can cause problems with the organ's functioning.
"We've followed people over time, we've looked at different markers of the virus as part of their clinical care and have confirmed there is significantly high rates of liver damage within the population of Aboriginal and Torres Strait Islander people who have this very specific sub-genotype of chronic hepatitis B," Prof Davies said.
Under current Australian guidelines, 25 per cent of the cohort studied are receiving treatment, Prof Davies said.
Researchers explored the potential impact of using World Health Organisation expanded treatment guidelines for people living with C4 hepatitis B.
Prof Davies said under the expanded guidelines half of those not currently being treated would be eligible for treatment.
While expanding the guidelines is a nuanced conversation, Prof Davies said, she believes it is common sense to do everything possible to support healthy liver function for those living with hepatitis B.
"My personal opinion is that we should be treating as many people as we can where there is evidence that we can reduce their risk of progression to liver failure and liver cancer," she said.
"That's where the really crucial question comes - is there evidence in this very specific sub-genotype in our setting that we should be immediately rolling out treatment to this more than roughly 50 per cent of people.
"That's definitely a nuanced conversation with pros and cons."
The study, representing the latest findings from the Hep B PAST program, which aims to eliminate hepatitis B in the NT, was published in BMC Infectious Diseases.
