www.hivandhepatitis.com

Antiviral Treatment for Hepatitis B Lowers Risk of Liver Cancer

Antiviral therapy for chronic hepatitis B virus (HBV) infection can reduce the risk of developing hepatocellular carcinoma (HCC), even among people with high HBV viral load, according to research described in the May 2014 edition of Clinical Gastroenterology and Hepatology.

Over years or decades chronic hepatitis B can lead to serious liver complications including cirrhosis and HCC. Treatment that suppresses HBV replication and reduces liver inflammation may lower the likelihood of advanced liver disease including liver cancer.

Stuart Gordon from the Henry Ford Health System in Detroit and fellow investigators with the Chronic Hepatitis C Cohort Study (CHeCS) looked at the relationship between hepatitis B treatment and HCC incidence using data from a longitudinal study of patients at 4 U.S. healthcare centers (Henry Ford, Geisinger Health System in Pennsylvania, Kaiser Permanente Northwest, and Kaiser-Permanent-Hawaii).

The researchers retrospectively analyzed electronic health record from 2671 adult participants in the cohort who received services between 2006 and 2010. A majority (56%) were men, half were Asian, about 20% were white, and 13% were black. Age groups <40, 40-50, 50-60, and >60 years were about equally represented. At study entry 28% had abnormal alanine aminotransferase (ALT) levels -- indicating liver inflammation -- while 55% had normal levels, known as immune-tolerant hepatitis B.

Of the 2671 participants, 820 (31%) received antiviral therapy for hepatitis B, with more than 90% receiving nucleoside/nucleotide analogs such as lamivudine (Epivir-HBV), adefovir (Hepsera), entecavir (Baraclude), telbivudine (Tyzeka), or tenofovir (Viread), either alone or with interferon. The median follow-up period was about 5 years and the median treatment duration was 45 months.

Results

• 20 patients (2.4%) who received hepatitis B treatment and 47 untreated participants (2.5%) developed primary HCC during follow-up.
• Crude HCC incidence rates were the same in both groups, at 4.2 per 1000 person-years.
• However, treated patients had a significantly lower risk of HCC after adjusting for abnormal ALT (adjusted hazard ratio 0.39, or 61% risk reduction).
• Antiviral treatment was also associated with a significantly lower risk of HCC in a subgroup analysis adjusting for fibrosis/cirrhosis biomarkers (adjusted hazard ratio 0.24, or 76% reduction).
• In a separate analysis, treated patients had a lower risk of HCC than untreated participants at all viral load levels, with the largest protective effect seen among people with HBV DNA >20,000 IU/mL.
• In a multivariate analysis, older age, male sex, abnormal ALT, and comorbidities were significant predictors of developing HCC, while antiviral treatment was protective.

"In a large geographically, clinically, and racially diverse U.S. cohort, antiviral therapy for chronic HBV infection was associated with a reduced risk for HCC," the study authors concluded.

"These findings corroborate existing and emerging evidence of the beneficial effect of antiviral therapy in reducing risk of HBV-related HCC," they elaborated in their discussion. "Most of these studies suggest that the reduced risk of carcinogenesis is the result of suppression of HBV through antiviral therapy; we found that antiviral treatment had a beneficial effect across a spectrum of viral load levels."

"The results of this study allow us to reassure our patients that we are not just treating their viral levels, but that antiviral therapy may actually lessen their chance of developing liver cancer," Gordon said in a Henry Ford Health System press release.

6/19/14

References

SC Gordon, LE Lamerato, LB Rupp, et al (CHeCS Investigators). Antiviral Therapy for Chronic Hepatitis B Virus Infection and Development of Hepatocellular Carcinoma in a US Population. Clinical Gastroenterology and Hepatology 12(5):885-893. May 2014.

AM Di Bisceglie. Prevention of hepatocellular carcinoma resulting from hepatitis B: Are we there yet?" Clinical Gastroenterology and Hepatology12(5):894-896. May 2014.

Other Source

Henry Ford Health System. Antiviral therapy may prevent liver cancer in Hepatitis B patients. Press release. June 9, 2014.