Journal
EXPERT REVIEW OF GASTROENTEROLOGY & HEPATOLOGY
Volume 15, Issue 11, Pages 1337-1344Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/17474124.2021.1980385
Keywords
Hepatitis B virus; maintenance of virologic response; entecavir; hepatocellular carcinoma; alanine aminotransferase
Categories
Funding
- National Science and Technology Major Project of China [2018ZX10715005]
- Special Fund of the Chinese Central Government for Basic Scientific Research Operations in Commonweal Research Institutes [2017PT63001]
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Among entecavir-treated chronic hepatitis B patients, those without maintaining virologic response are at higher risk of hepatocellular carcinoma, especially those with cirrhosis or a high predicted HCC score. For patients maintaining virologic response, the trajectories of ALT after response can indicate different risks of HCC.
Introduction The treatment evidence for entecavir-treated chronic hepatitis B (CHB) patients without maintaining of virologic response (MVR, defined as persistent HBV DNA <20 IU/mL during therapy) remains uncertain. We aimed to determine the relationship between non-MVR and hepatocellular carcinoma (HCC) risk in entecavir-treated CHB patients. Methods A cohort of 1447 entecavir-treated CHB patients were enrolled. Multivariate and propensity score-based inverse probability weighting (IPW) model was performed to estimate the effect of MVR on HCC. Results During a median follow-up of 5 years, 214 (14.8%) patients occurred with non-MVR. Non-MVR patients had a higher risk of HCC [the IPW model: hazard ratio (HR) = 3.59, 95% confidence interval (CI): 2.23-5.75] than MVR patients, especially in those with cirrhosis (HR = 4.60, 95% CI: 2.81-7.56) and the high HCC score by the Chinese University of Hong Kong (HR = 4.35, 95% CI: 2.58-7.32). MVR patients with transient (HR = 4.72, 95% CI: 1.98-11.24) or persistent (HR = 12.16, 95% CI: 3.58-41.31) abnormal ALT after virologic response had higher HCC hazard. Conclusions Our study indicated an elevated HCC probability for entecavir-treated CHB patients with Non-MVR, especially for those with cirrhosis or a high predicted score at baseline. For MVR patients, the trajectories of ALT after virologic response suggested different HCC risks.
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