In:
Clinical and Molecular Hepatology, The Korean Association for the Study of the Liver, Vol. 27, No. 2 ( 2021-04-01), p. 295-304
Kurzfassung:
Background/Aims: The immune-tolerant (IT) phase of chronic hepatitis B (CHB) patients is not generally indicative of antiviral therapy (AVT). We assessed and compared the risk of hepatocellular carcinoma (HCC) during the IT-phase stringently defined by a low fibrosis-4 (FIB-4) index, compared to that in patients undergoing AVT.Methods: Among 125 untreated patients that were hepatitis B e-antigen positive, hepatitis B virus-DNA 〉 20,000 IU/mL, with normal alanine aminotransferase level from 2012 to 2018, those with a FIB-4 index of 〈 1.45 were classified into the IT-group. The cumulative probability of HCC was estimated using Kaplan-Meier analysis. All patients were assessed until HCC development (intention-to-treat [ITT] analysis), whereas those suspected of experiencing CHB phase switch were assessed using the per-protocol (PP) and censored at the time of phase switch.Results: The cumulative probability of HCC at 1-, 3-, and 5-years among the IT-group was zero, compared to AVT-treated patients with FIB-4 indices 〈 1.45 during the same period: 0.2%, 0.6%, and 1.4%, respectively (P=0.264 for ITT and P=0.533 for PP). Among the initially screened 125 untreated patients, those with a FIB-4 index of ≥1.45 had a higher risk of HCC compared to the IT-group (P=0.005). Furthermore, among AVT-treated patients, those with a FIB-4 index of ≥1.45 had a higher risk of HCC compared to their counterpart (P 〈 0.001).Conclusions: The risk of HCC was negligible in the IT-group stringently defined by a low FIB-4 index. However, given that a higher HCC risk exists among untreated patients with higher FIB-4, appropriate criteria for AVT should be established.
Materialart:
Online-Ressource
ISSN:
2287-2728
,
2287-285X
DOI:
10.3350/cmh.2020.0216
Sprache:
Englisch
Verlag:
The Korean Association for the Study of the Liver
Publikationsdatum:
2021
ZDB Id:
2672531-9
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