Lower liver cancer risk with antiviral therapy in chronic hepatitis B patients with normal to minimally elevated ALT and no cirrhosis.
Medicine (Baltimore)
; 95(31): e4433, 2016 Aug.
Article
en En
| MEDLINE
| ID: mdl-27495067
ABSTRACT
For chronic hepatitis B (CHB), alanine aminotransferase (ALT) ≥2â×âupper limit of normal (ULN) is often used as a major criteria to initiate treatment in absence of cirrhosis, though patients with lower ALT may not be free from future risk of hepatocellular carcinoma (HCC). We aimed to examine the effect of antiviral therapy on HCC incidence based on ALT levels.We performed a retrospective study on 3665 patients consisting of United States and Taiwanese REVEAL-HBV cohort who were consecutive, treatment-naïve, noncirrhotic CHB patients aged ≥40 years. Patients were categorized by ALT cutoffs (≥2â×âULN vs <2â×âULN) and subgrouped by treatment status. Kaplan-Meier and Cox proportional hazards models were used to calculate cumulative incidence and hazard ratio (HR) of HCC adjusting for REACH-B scores.A total of 202 patients developed HCC. Antiviral treatment significantly reduced HCC risk HR 0.24, 95% confidence interval 0.10-0.58; Pâ=â0.001. HCC incidence per 100,000 person-years was significantly higher in untreated versus treated patients, even for those with ALTâ<â2â×âULN 314.46 versus 0 per 100,000 person-years, Pâ=â0.0042. For patients with Hepatitis B Virus (HBV) Deoxyribonucleic Acid (DNA)â≥â2000âIU/mL, the number-needed-to-treat (NNT) were 15 and 14 to prevent 1 incident HCC at year 10 for patients with ALTâ<â2â×âULN and ≥2â×âULN, respectively.After adjustment by REACH-B score, antiviral treatment significantly decreased HCC incidence even in patients with ALTâ<â2â×âULN. NNT to prevent 1 incident HCC after 10 years of therapy was low (14-15) in patients with mildly elevated HBV DNAâ≥â2000âIU/mL regardless of ALT levels.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Antivirales
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Hepatitis B Crónica
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Transaminasas
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Neoplasias Hepáticas
Tipo de estudio:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Medicine (Baltimore)
Año:
2016
Tipo del documento:
Article