임영석 (울산대학교 의과대학)

한빛사논문

조회355

울산대학교 의과대학

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J. Clin. Invest., 2022 Mar 31;e154833 | https://doi.org/10.1172/JCI154833 Increasing on-treatment hepatocellular carcinoma risk with decreasing baseline viral load in HBeAg-positive chronic hepatitis B

Won-Mook Choi,¹ Gi-Ae Kim,² Jonggi Choi,¹ Seungbong Han,³ and Young-Suk Lim¹

¹Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea ²Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea ³Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea

Corresponding Author: Young-Suk Lim

Abstract

BACKGROUND. It is unclear whether the level of serum hepatitis B virus (HBV) DNA at baseline impacts the on-treatment risk of hepatocellular carcinoma (HCC) in HBeAg positive, non-cirrhotic patients with chronic hepatitis B (CHB).

METHODS. We conducted a multicenter cohort study including 2,073 entecavir- or tenofovir-treated, HBeAg-positive, non-cirrhotic, adult CHB patients with baseline HBV DNA levels ≥5.00 log₁₀ IU/mL at three centers in Korea between January 2007 and December 2016. We evaluated the on-treatment incidence rate of HCC by baseline HBV DNA levels.

RESULTS. During a median 5.7 years of continuous antiviral treatment, 47 patients developed HCC (0.39 per 100 person-years). By Kaplan–Meier analysis, HCC risk was the lowest in those with baseline HBV DNA levels ≥8.00 log₁₀ IU/mL, increased incrementally with decreasing viral load, and the highest with HBV DNA levels 5.00–5.99 log₁₀ IU/mL (P<0.001). By multivariable analysis, baseline HBV DNA level was an independent factor that was inversely associated with HCC risk. Compared with HBV DNA ≥8.00 log₁₀ IU/mL, the adjusted hazard ratios for HCC risk with HBV DNA 7.00–7.99 log₁₀ IU/mL, 6.00–6.99 log₁₀ IU/mL, and 5.00–5.99 log₁₀ IU/mL were 2.48 (P=0.03), 3.69 (P=0.002), and 6.10 (P<0.001), respectively.

CONCLUSION. On-treatment HCC risk increased incrementally with decreasing baseline HBV DNA levels in the range of ≥5.00 log₁₀ IU/mL in HBeAg-positive, non-cirrhotic, adult patients with CHB. Early initiation of antiviral treatment with a high viral load (≥8.00 log₁₀ IU/mL) may maintain the lowest risk of HCC in those patients.

논문정보

형식Research article
게재일2022년 03월 (BRIC 등록일 2022-04-12)
연구진국내 연구진
분야 의약학 > 응용의학

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