The dual role of regulatory T cells in hepatitis B virus infection and related hepatocellular carcinoma

Hepatocellular carcinoma (HCC) represents a significant global cause of cancer-related mortality. Hepatitis B virus (HBV)infection is a major etiologic factor leading to HCC. While noteworthy progress has been made in managing HBV replication, achieving a cure for HBV-related HCC (HBV-HCC) remains challenging, and the overall survival outcome for HCC remains suboptimal. HBV persistence is attributed to a myriad of mechanisms, encompassing both innate and adaptive immune responses. Regulatory T cells(Tregs) are pivotal in upholding immune tolerance and modulating excessive immune activation. During HBV infection, Tregs mediate specific T cell suppression, thereby contributing to both persistent infection and the mitigation of liver inflammatory responses. Studies have demonstrated an augmented expression of circulating and intrahepatic Tregs in HBV-HCC, which correlates with impaired CD8 T cells function. Consequently, Tregs play a dual role in the context of HBV infection and the progression of HBV-HCC. In this comprehensive review, we discuss pertinent studies concerning Tregs in HBV infection, HBV-related cirrhosis and HCC. Furthermore, we provide valuable treatment strategies pertinent to liver cancer management.