The long-term benefits of nucleos(t)ide analogs in compensated HBV cirrhotic patients with no or small esophageal varices: A 12-year prospective cohort study

Pietro Lampertico, Federica Invernizzi, Mauro Viganò, Alessandro Loglio, Giampaolo Mangia, Floriana Facchetti, Massimo Primignani, Manol Jovani, Massimo Iavarone, Mirella Fraquelli, Giovanni Casazza, Roberto De Franchis, Massimo Colombo

Research output: Contribution to journalArticle

Abstract

Background & Aims Esophageal varices (EV) are a marker of disease severity in compensated cirrhosis due to hepatitis B virus (HBV) which predicts also the risk of hepatocellular carcinoma (HCC), clinical decompensation and anticipated liver related death. The dynamics and prognostic significance of EV in patients under long-term HBV suppression by nucleos(t)ide analogs (NUC), are poorly known. Methods A standardized protocol (Baveno) including 414 upper gastrointestinal (GI) endoscopies was applied to 107 HBeAg-negative compensated cirrhotic patients (93% Child-Pugh A) during a median of 12 (range 2 to 17) years of NUC therapy. Patients who initially started on lamivudine (LMV) and then developed resistance (LMV-R), were rescued by early administration of adefovir, or were switched to tenofovir. Surveillance included serum HBV DNA every three months and abdominal ultrasound every six months. Results Twenty-seven patients had baseline F1 EV which regressed in 18, remained unchanged in eight and progressed in one patient; the 12-year cumulative incidence of EV regression was 83% (95% CI: 52-92%). De novo F1/F2 EV developed in 6/80 patients with a 12-year cumulative incidence of 10% (95% CI: 5-20%). Six of seven patients with de novo varices or progression of pre-existing varices had either a clinical breakthrough due to LMV-R and/or developed a HCC. No bleedings from ruptured EV occurred, 12 patients died (9 HCC) and 15 were transplanted (13 HCC): the 12-year cumulative incidence of HCC and overall survival was 33% (95% CI: 24-42%) and 76% (95% CI: 67-83%), respectively. Conclusions Long-term pharmacological suppression of HBV in HBeAg-seronegative patients with compensated cirrhosis leads to a significant regression of pre-existing EV accompanied by a negligible risk of developing de novo EV.

Original languageEnglish
Pages (from-to)1118-1125
Number of pages8
JournalJournal of Hepatology
Volume63
Issue number5
DOIs
Publication statusPublished - Nov 1 2015

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Keywords

  • Cirrhosis
  • Esophageal varices
  • Gastrointestinal bleeding
  • HBsAg clearance
  • Hepatitis B virus
  • Hepatocellular carcinoma
  • Nucleos(t)ide analogs
  • Transient elastography

ASJC Scopus subject areas

  • Hepatology

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