title: Lower liver cancer risk with antiviral therapy in chronic hepatitis B patients with normal to minimally elevated ALT and no cirrhosis.
abstract: For chronic hepatitis B (CHB), alanine aminotransferase (ALT) ≥2 × upper limit of normal (ULN) is often used as a major criteria to initiate treatment in absence of cirrhosis, though patients with lower ALT may not be free from future risk of hepatocellular carcinoma (HCC). We aimed to examine the effect of antiviral therapy on HCC incidence based on ALT levels.We performed a retrospective study on 3665 patients consisting of United States and Taiwanese REVEAL-HBV cohort who were consecutive, treatment-naïve, noncirrhotic CHB patients aged ≥40 years. Patients were categorized by ALT cutoffs (≥2 × ULN vs <2 × ULN) and subgrouped by treatment status. Kaplan-Meier and Cox proportional hazards models were used to calculate cumulative incidence and hazard ratio (HR) of HCC adjusting for REACH-B scores.A total of 202 patients developed HCC. Antiviral treatment significantly reduced HCC risk: HR 0.24, 95% confidence interval 0.10-0.58; P = 0.001. HCC incidence per 100,000 person-years was significantly higher in untreated versus treated patients, even for those with ALT < 2 × ULN: 314.46 versus 0 per 100,000 person-years, P = 0.0042. For patients with Hepatitis B Virus (HBV) Deoxyribonucleic Acid (DNA) ≥ 2000 IU/mL, the number-needed-to-treat (NNT) were 15 and 14 to prevent 1 incident HCC at year 10 for patients with ALT < 2 × ULN and ≥2 × ULN, respectively.After adjustment by REACH-B score, antiviral treatment significantly decreased HCC incidence even in patients with ALT < 2 × ULN. NNT to prevent 1 incident HCC after 10 years of therapy was low (14-15) in patients with mildly elevated HBV DNA ≥ 2000 IU/mL regardless of ALT levels.
authors: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA Genomics Research Center, Academia Sinica Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan Stanford Cancer Institute, Stanford Medicine, Stanford Department of Internal Medicine, University of California, San Diego Department of Medicine, Stanford University Medical Center, Stanford San Jose Gastroenterology, San Jose Gastroenterology, Palo Alto Medical Foundation, Mountain View Primary Care, Chinese Hospital, San Francisco, California, USA Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
authors: Joseph K
authors: JK
authors: Hoang
authors: Hwai-I
authors: HI
authors: Yang
authors: An
authors: A
authors: Le
authors: Nghia H
authors: NH
authors: Nguyen
authors: Derek
authors: D
authors: Lin
authors: Vinh D
authors: VD
authors: Vu
authors: Kevin
authors: K
authors: Chaung
authors: Vincent
authors: V
authors: Nguyen
authors: Huy N
authors: HN
authors: Trinh
authors: Jiayi
authors: J
authors: Li
authors: Jian Q
authors: JQ
authors: Zhang
authors: Chien-Jen
authors: CJ
authors: Chen
authors: Mindie H
authors: MH
authors: Nguyen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000503:physiopathology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D000637:Transaminases / Q000097:blood*
chemical_list: D000998:Antiviral Agents; D000637:Transaminases