Long term nucleotide and nucleoside analogs treatment in chronic hepatitis B HBeAg negative genotype D patients and risk for hepatocellular carcinoma

Adriano M. Pellicelli, Pascal Vignally, Vincenzo Messina, Antonio Izzi, Ettore Mazzoni, Angelo Barlattani, Donato Bacca, Mario Romano, Fabrizio Mecenate, Tommaso Stroffolini, Caterina Furlan, Antonio Picardi, Umberto V. Gentilucci, Roberto Gulminetti, Maria E. Bonaventura, Roberto Villani, Cecilia D'Ambrosio, Amerigo Paffetti, Cristina Mastropietro, Massimo MarignaniLucia Fondacaro, Giuseppe Cerasari, Arnaldo Andreoli, Giorgio Barbarini

Research output: Contribution to journalArticlepeer-review

Abstract

Background and rationale of the study. Effect of Long-term nucleoside/nucleotide (NUC) on hepatocellular carcinoma (HCC) incidence in a population of HBeAg-negative genotype D patients has not been adequately studied in real-life cohorts. Our aim was to evaluate the impact of liver fibrosis and other variables on HCC incidence in this population of patients. Of 745 patients with chronic hepatitis B (CHB), 306 HBeAg-negative genotype D were selected and included in this study. All patients received treatment with NUC for at least 18 months. Patients with CHB or compensated cirrhosis were included. Patients with HCC diagnosed before or during the first 18 months of NUC therapy were excluded. Results. HCC was diagnosed in 2 CHB patients (1.0%) and 23 cirrhosis patients (20%) (OR = 24.41, 95% CI 5.40 <OR <153.2; p <0.0001). Multivariate analysis revealed that HCC risk was independently associated with age ≥ 60 years (OR = 6.45, 95% CI 1.22 to 34.0; p = 0.02) and liver cirrhosis (OR = 12.1, 95% CI 1.39 to 106.2; p = 0.02), but not with virological response (VR), and previous resistance to NUC, or rescue therapy. Multivariate analysis in cirrhosis patients revealed that only age ≥ 60 years was an independent risk factor associated with HCC (p = 0.003). Conclusions. Liver cirrhosis and age ≥ 60 years are the stronger risk factors for HCC in genotype D HBeAgnegative patients. Previous resistance to NUC in patients that achieved a VR after rescue therapy was not a predictive factor regarding HCC. VR does not appear to significantly reduce the overall incidence of HCC when a patient has already progressed to liver cirrhosis.

Original languageEnglish
Pages (from-to)376-385
Number of pages10
JournalAnnals of Hepatology
Volume13
Issue number4
Publication statusPublished - 2014

Keywords

  • Hepatitis B
  • Lamivudine
  • Resistance

ASJC Scopus subject areas

  • Hepatology
  • Medicine(all)

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