cosunter【300436】
Antiviral Therapy and HCC Reduction
Patients with cirrhosis are at particular risk for liver failure and HCC. Antiviral therapy is currently recommended for patients with cirrhosis who have a high HBV DNA load (≥ 2000 IU/mL). However, guidelines vary for patients with cirrhosis who have a low HBV DNA load.
Gao and colleagues evaluated the effect of antiviral therapy on the incidence of HCC in patients with cirrhosis with lower HBV DNA levels.[3] A total of 381 consecutive patients with cirrhosis from a US cohort (277 had received antiviral therapy) and 408 patients from a community-based Taiwanese cohort (none had received treatment) were accessed to determine the incidence of HCC during long-term follow-up. These patients were classified into two groups based on their serum HBV DNA level: low (< 20 IU/mL) and high (≥ 20 IU/mL). Each group was further stratified into treated and untreated subgroups. The majority of patients in both groups were Asian and male (77%), and had similar baseline age, alanine aminotransferase levels, and aspartate aminotransferase levels.
During a median follow-up of 5 years, researchers detected 191 incident cases of HCC. The 5-, 10-, and 15-year cumulative incidence rates of HCC in treated patients were 12%, 23%, and 23%, respectively, in the group with high HBV DNA levels. Antiviral therapy significantly reduced the incidence of HCC in the high-serum-level group. In the group with low serum HBV DBA levels, the cumulative incidence rates of HCC did not significantly differ between treated and untreated patients on follow-up at 5 years (17% vs 11%), 10 years (38% vs 21%), or 15 years (38% vs 30%). On multivariate analysis, antiviral therapy was an independent predictor of a lower incidence of HCC in patients with an HBV DNA level ≥ 20 IU/mL, after adjustment for age, sex, hepatitis B e antigen, and liver function.
Because antiviral therapy led to a significant reduction in the incidence of HCC in patients with chronic hepatitis B, administration should be considered for patients with HBV cirrhosis, including those with lower viral loads—a group previously thought to be at low risk.