Head‐to‐Head Comparison of Long‐Term HCC Risk of Antivirals‐Treated Versus Untreated Low‐Level Viremia in HBV‐Compensated Cirrhosis
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Among patients with hepatitis B virus (HBV)-infected compensated cirrhosis and low-level viremia, there are limited data for comparative outcomes between those treated with oral nucleos(t)ide analogs versus those not. We conducted a large, multi-ethnic, multi-center study to examine the impact of antiviral treatment (AVT) on long-term hepatocellular carcinoma (HCC) risk for compensated cirrhosis and low-level viremia. METHODS: Patients with compensated cirrhosis and low-level viremia (serum HBV-DNA 20-2000 IU/mL) at baseline or before AVT were screened for eligibility from 19 hospitals in South Korea, Singapore, and Japan. The primary outcome was HCC development, compared between those receiving AVT versus those untreated throughout follow-up. RESULTS: Among 848 patients (mean age 55.7 years and 66.9% male), AVT (n = 233) was associated with significantly lower annual HCC incidence compared to non-AVT (n = 615); 1.72/100 versus 2.99/100 person-years (PY), respectively (p = 0.033). Multivariable Cox-regression analyses determined that AVT was associated with significantly lower HCC risk, compared to non-AVT (adjusted HR [HR] 0.514, 95% confidence interval [CI] 0.271-0.976; p = 0.042). In a landmark analysis, HCC incidence was similar between two groups until 18 months, but after this landmark, the treated group had the significantly lower HCC risk compared to untreated group (p = 0.012). Furthermore, propensity score-matching analysis consistently showed that AVT was associated with significantly lower HCC risk, compared to non-AVT; the annual HCC incidence of 1.45/100 PYs versus 2.73/100 PY, respectively (p = 0.043). CONCLUSIONS: Patients with compensated cirrhosis and low-level viremia may benefit from long-term AVT, highlighting appropriate amendment of reimbursement guidelines.
DOI: 10.1111/jgh.16986
Institutions: Musashino Red Cross Hospital, National University of Singapore, National University Hospital, Yonsei University, Yonsei University Health System, Kyungpook National University, Samsung Medical Center, Sungkyunkwan University, Osaka Red Cross Hospital, Matsuyama Red Cross Hospital, Otsu Red Cross Hospital, Matsue Red Cross Hospital, Okayama Red Cross General Hospital, Masuda Red Cross Hospital
Language: English
Topic: Hepatitis B Virus Studies
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: G1788523883, 多様な病態に対応可能な肝疾患のトータルケアに資する人材育成及びその活動の質の向上等に関する研究, 次世代シークエンス技術を基盤としたC 型肝炎ウイルス排除後における肝癌出現機序・病態変化の解明とバイオマーカーの開発, B型肝炎の個別化医療を目指した臨床ゲノム解析に関する研究と肝炎データストレージの利活用, インターフェロンフリー治療がC型肝硬変患者の予後を含めたアウトカムに与える影響を明らかにする研究, G5397796986, 指標等を活用した地域の実情に応じた肝炎対策均てん化の促進に資する研究, G8849576777, 肝がん・重度肝硬変の医療水準と患者のQOL向上等に資する研究
OpenAlex ID: W4409855549