Delayed viral suppression during antiviral therapy is associated with increased hepatocellular carcinoma rates in HB HB eAg‐positive high viral load chronic hepatitis B

摘要

Summary The treatment option in chronic hepatitis B ( CHB ) patients with persistent low‐level viremia despite entecavir or tenofovir monotherapy is unclear. This study investigated the development of hepatocellular carcinoma ( HCC ) or cirrhosis in hepatitis B e antigen ( HB eAg)‐positive high viral load CHB patients, according to the time needed to achieve complete viral suppression. A total of 325 HB eAg‐positive CHB patients with high viral load who were recently started on antiviral therapy with entecavir or tenofovir were included. The enrolled patients were divided into 2 groups with 4 separate criteria based on the time needed to achieve complete viral suppression: within 1, 2, 3 or 4?years of therapy initiation. The outcomes were development of HCC and cirrhosis. The cumulative incidence of HCC was significantly higher in patients failing complete viral suppression within 1?year (hazard ratio ( HR ), 4.54; 95% confidence interval ( CI ), 1.03‐19.93; P? = ? .045) or 2?years ( HR , 3.38; 95% CI , 1.24‐9.23; P? = ? .018), than patients who achieved complete viral suppression within 1 or 2?years, respectively. Cumulative incidence of cirrhosis was also significantly higher in patients failing suppression within 1?year ( HR , 1.95; 95% CI , 1.04‐3.66; P? = ? .037) or 2?years ( HR , 2.44; 95% CI , 1.41‐4.22; P? = ? .001). When the time for achieving viral suppression exceeded 2?years, the cumulative incidence of HCC or cirrhosis was not different regardless of viral suppression. Complete hepatitis B virus suppression within 2?years of antiviral therapy initiation is associated with risk reduction in HCC or cirrhosis development.