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울산대학교 의과대학, 서울아산병원

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Am. J. Gastroenterol., 2023 Jan 9 | doi: 10.14309/ajg.0000000000002181 Low level of hepatitis B viremia compared with undetectable viremia increases the risk of hepatocellular carcinoma in patients with untreated compensated cirrhosis

Jiwon Yang ¹, Won-Mook Choi¹, Ju Hyun Shim¹, Danbi Lee¹, Kang Mo Kim¹, Young-Suk Lim¹, Han Chu Lee¹, Jonggi Choi^1,a

¹Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

^aCorrespondence to: Jonggi Choi, MD, PhD

Abstract

Background and aims: The initiation of antiviral treatment in chronic hepatitis B (CHB) patients with compensated cirrhosis and low-level viremia (LLV; HBV DNA 15-2,000 IU/mL) remains controversial. We sought to compare the long-term outcomes of these untreated patients according to their viremic status.

Methods: 627 CHB untreated patients with compensated cirrhosis were analyzed retrospectively. The risk of hepatocellular carcinoma (HCC) and liver-related clinical events, including hepatic decompensation, were compared between patients with LLV and undetectable HBV DNA. Patients who received antiviral treatment were censored at the time of treatment initiation.

Results: The mean age of the patients was 54.7 years, 64.4 % of whom were male. During the study period, 59 patients developed HCC (20 and 39 in the undetectable and LLV groups, respectively) with an annual incidence of 2.44/100 person-years (PYs). Multivariable analysis revealed that the LLV group was associated with a significantly higher risk of HCC (adjusted hazard ratio [HR]: 2.36, p=0.002) than the undetectable group. In the 204 propensity-score (PS) matched cohort, the LLV group had a 2.16-fold greater risk of HCC than the undetectable group (p=0.014). Liver-related clinical events occurred in 121 patients with an annual incidence of 5.25/100 PYs. Despite not reaching statistical significance, the LLV group tended to have a higher risk of liver-related events in the PS-matched cohort (HR: 1.14, p=0.50).

Conclusion: Compared with patients with undetectable HBV DNA, those with compensated cirrhosis and LLV had a significantly higher risk of HCC. Antiviral treatment should be advised for these patients.

논문정보

형식Research article
게재일2023년 01월 (BRIC 등록일 2023-01-11)
연구진국내 연구진
분야 의약학 > 응용의학

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