한빛사논문
- 조회1,195
성균관대학교 의과대학, 삼성서울병원
Abstract
Jung Hee Kim, Dong Hyun Sinn, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh and Seung Woon Paik*
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
*Corresponding author: Seung Woon Paik, MD, PhD, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351, Seoul, South Korea,
Abstract
It is controversial whether low-level viremia (LLV;＜2,000 IU/mL) on entecavir monotherapy can be monitored or requires a change in therapy, as the long-term clinical impact of LLV is not well-known. A retrospective cohort of 875 treatment-naive chronic hepatitis B virus (HBV) mono-infected patients [mean age: 47.7 years, male = 564 (65.5%), cirrhosis = 443 (50.6%)] who received entecavir monotherapy were analyzed for the development of hepatocellular carcinoma (HCC). The HCC risk was compared between patients who maintained virological response (MVR), defined by persistently undetectable HBV DNA (< 12 IU/mL), and patients who experienced LLV, defined by either persistent or intermittent episodes of less than 2,000 IU/mL detectable HBV DNA. During a median 4.5 years of follow-up (range: 1.0 - 8.7 years), HCC was diagnosed in 85 patients (9.7%). HCC developed more frequently in patients who experienced LLV than MVR (14.3% vs. 7.5% at 5 years, P = 0.015). The hazard ratio comparing those with LLV to MVR was 1.98 (95% confidence interval = 1.28-3.06, P = 0.002, adjusted for age, sex, hepatitis B e antigen, baseline HBV DNA levels and cirrhosis). Among cirrhotic patients, those with LLV showed a significantly higher HCC risk than MVR [HCC incidence rate at 5 years: 23.4% vs. 10.3%, adjusted hazard ratio (95% confidence interval): 2.20 (1.34-3.60), P = 0.002] However, for non-cirrhotic patients, there was no significant difference in the HCC risk between LLV and MVR. Conclusion: LLV observed during entecavir monotherapy was associated with a higher risk of HCC, especially for those with cirrhosis, indicating that LLV during potent antiviral therapy is not harmless situation. This article is protected by copyright. All rights reserved.
Keywords : hepatitis B virus; antiviral therapy; hepatocellular carcinoma; virological response; entecavir
논문정보
- Research article
- 2016년 11월 (BRIC 등록일 2016-11-16)
- 국내 연구진
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