Risk of HBV reactivation according to viral status and treatment intensity in patients with hepatocellular carcinoma.
BACKGROUND
There are no convincing data supporting the routine use of pre-emptive therapy against HBV reactivation in various loco-regional therapies for hepatocellular carcinoma (HCC). This study investigated the incidence, severity and risk factors of HBV reactivation during loco-regional therapies.


METHODS
A total of 205 prospectively enrolled patients were classified in order of increasing intensity of loco-regional therapies: local ablation therapy (LAT; 43 patients), transarterial chemotherapy using adriamycin (TAC-ADR; 93 patients) or combined epirubicin-cisplatin (TAC-EC; 26 patients), and combined chemo-radiotherapy (TAC-EC+RT; 43 patients).


RESULTS
During the follow-up, 62 (30.2%) patients developed HBV reactivation. Multivariate analysis identified HBV DNA levels >10⁴ copies/ml (P=0.041) and treatment option (P=0.001) to be independent predictors of HBV reactivation. There was a significant trend for increasing risk of reactivation with increasing intensity of therapy, with hazard ratios of 1.0 for LAT, 2.45 for TAC-ADR, 4.19 for TAC-EC and 10.17 for TAC-EC+RT. The severity of reactivated disease was also increased with increasing treatment intensity (P-value for trend <0.05). Only one of the patients with low-level viraemia receiving LAT alone developed reactivation, whereas a substantial number of patients with high-level viraemia eventually developed reactivation.


CONCLUSIONS
High-level viraemia and high-level treatment intensity are the major risk factors for HBV reactivation during loco-regional therapy. Trends are evident for the increased risk and severity of reactivation with the aggressiveness of treatment. Pre-emptive antiviral therapy should be recommended for all patients with high-level viraemia irrespective of treatment option, or those undergoing any intensive therapy.
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. garden@catholic.ac.kr
Jeong Won
JW
Jang
Jung Hyun
JH
Kwon
Chan Ran
CR
You
Jin Dong
JD
Kim
Hyun Young
HY
Woo
Si Hyun
SH
Bae
Jong Young
JY
Choi
Seung Kew
SK
Yoon
Kyu Won
KW
Chung
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006509:Hepatitis B / Q000473:pathology / Q000821:virology*; D006514:Hepatitis B Surface Antigens; D006515:Hepatitis B virus / Q000472:pathogenicity*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D019562:Viral Load; D014775:Virus Activation
D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens