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Antiviral therapy substantially reduces HCC risk in patients with chronic hepatitis B infection in the indeterminate
Daniel Q Huang1,2, Andrew Tran3, Ming-Lun Yeh4
1Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore.
Insights
Antiviral therapy significantly lowers hepatocellular carcinoma (HCC) risk in patients with indeterminate-phase chronic hepatitis B (CHB). This finding supports expanding treatment criteria for CHB to reduce HCC development.
Area of Science:
- Hepatology
- Viral Hepatitis
- Oncology
Background:
- Hepatocellular carcinoma (HCC) risk is elevated in chronic hepatitis B (CHB) indeterminate phase compared to inactive phase.
- The benefit of antiviral therapy in reducing HCC risk within the indeterminate CHB phase remains unclear.
Purpose of the Study:
- To evaluate the association between antiviral therapy and HCC risk in patients with indeterminate-phase CHB.
- To determine if antiviral treatment can mitigate HCC development in this specific patient group.
Main Methods:
- Analysis of 855 treatment-naïve adult CHB patients without advanced fibrosis in the indeterminate phase.
- Utilized Inverse Probability of Treatment Weighting (IPTW) to balance treated and untreated groups.
- Primary outcome was HCC development, analyzed using multivariable Cox proportional hazards models.
Main Results:
- After IPTW, 5-, 10-, and 15-year cumulative HCC incidence was 3%, 4%, and 9% in treated patients versus 3%, 15%, and 19% in untreated patients (p=0.02).
- Antiviral therapy was an independent predictor of reduced HCC risk (adjusted HR=0.3, 95% CI: 0.1-0.6, p=0.001).
- Consistent findings were observed across subgroup analyses including age, sex, HBeAg status, HBV DNA levels, and ALT levels.
Conclusions:
- Antiviral therapy demonstrates a 70% reduction in HCC risk for patients with indeterminate-phase CHB.
- These findings suggest a potential expansion of treatment criteria for CHB to improve patient outcomes and reduce HCC incidence.
Background And Aims:
HCC risk in chronic hepatitis B (CHB) is higher in the indeterminate phase compared with the inactive phase. However, it is unclear if antiviral therapy reduces HCC risk in this population. We aimed to evaluate the association between antiviral therapy and HCC risk in the indeterminate phase.
Approach And Results:
We analyzed 855 adult (59% male), treatment-naïve patients with CHB infection without advanced fibrosis in the indeterminate phase at 14 centers (USA, Europe, and Asia). Inverse probability of treatment weighting (IPTW) was used to balance the treated (n = 405) and untreated (n = 450) groups. The primary outcome was HCC development. The mean age was 46±13 years, the median alanine transaminase was 38 (interquartile range, 24-52) U/L, the mean HBV DNA was 4.5±2.1 log 10 IU/mL, and 20% were HBeAg positive. The 2 groups were similar after IPTW. After IPTW (n = 819), the 5-, 10-, and 15-year cumulative HCC incidence was 3%, 4%, and 9% among treated patients (n = 394) versus 3%, 15%, and 19%, among untreated patients (n = 425), respectively ( p = 0.02), with consistent findings in subgroup analyses for age >35 years, males, HBeAg positive, HBV DNA>1000 IU/mL, and alanine transaminase
Conclusions:
Antiviral therapy reduces HCC risk by 70% among patients with indeterminate-phase CHB. These data have important implications for the potential expansion of CHB treatment criteria.
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