Hepatitis B Virus Treatment and Hepatocellular Carcinoma: Controversies and Approaches to Consensus
Background: Long-term therapy with nucleos(t)ide analogs (NAs) such as entecavir (ETV) and tenofovir disoproxil fumarate (TDF) favorably affects the incidence of hepatocellular carcinoma (HCC) on the basis of data from randomized or matched control studies. Recent data suggest a lower HCC incidence...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2022-08-01
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| Series: | Liver Cancer |
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| Online Access: | https://www.karger.com/Article/FullText/525518 |
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| author | Soo Ki Kim Takako Fujii Soo Ryang Kim Atsushi Nakai Young-Suk Lim Satoru Hagiwara Masatoshi Kudo |
| author_facet | Soo Ki Kim Takako Fujii Soo Ryang Kim Atsushi Nakai Young-Suk Lim Satoru Hagiwara Masatoshi Kudo |
| author_sort | Soo Ki Kim |
| collection | DOAJ |
| description | Background: Long-term therapy with nucleos(t)ide analogs (NAs) such as entecavir (ETV) and tenofovir disoproxil fumarate (TDF) favorably affects the incidence of hepatocellular carcinoma (HCC) on the basis of data from randomized or matched control studies. Recent data suggest a lower HCC incidence after 5 years of ETV or TDF therapy in chronic hepatitis B (CHB) patients, especially those with baseline cirrhosis. Summary: Three controversial issues remain to be resolved regarding hepatitis B virus (HBV) treatment and HCC. (1) The efficacy of antiviral treatment for the prevention of HCC is not established. The guidelines of the American Association for the Study of Liver Diseases (AASLD), the Asian Pacific Association for the Study of the Liver (APASL), and the European Association for the Study of the Liver (EASL) for the management of HBV infection state that antiviral treatment of HBV with interferon and NAs prevents the development of HCC. Among experts in CHB treatment, however, there is disagreement on the HCC prevention effects of antiviral treatment. (2) The rationale for antiviral management in patients with high HBV DNA and normal levels of alanine aminotransferase is unclear. The AASLD, EASL, and APASL guidelines do not recommend antiviral treatment for immune-tolerant CHB patients, and the terms and methods of treating such patients remain to be clarified. (3) The efficacy of first-line treatment with NAs, including ETV, TDF, and tenofovir alafenamide fumarate (TAF), to prevent HCC in CHB patients remains unknown. Several studies have produced controversial results regarding the effects of NAs on the risk and prevention of HCC. In the present review, we discuss these 3 issues, citing recent studies and clinical management guidelines from major international associations. Key Messages: Suggested approaches for reaching a consensus including applying the propensity score matching method, performing randomized controlled studies, and performing clinical studies with larger numbers of subjects and longer follow-up. |
| first_indexed | 2024-04-12T19:13:22Z |
| format | Article |
| id | doaj.art-38247271ed5c4a0f905b154c233f7023 |
| institution | Directory Open Access Journal |
| issn | 2235-1795 1664-5553 |
| language | English |
| last_indexed | 2024-04-12T19:13:22Z |
| publishDate | 2022-08-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Liver Cancer |
| spelling | doaj.art-38247271ed5c4a0f905b154c233f70232022-12-22T03:19:48ZengKarger PublishersLiver Cancer2235-17951664-55532022-08-0110.1159/000525518525518Hepatitis B Virus Treatment and Hepatocellular Carcinoma: Controversies and Approaches to ConsensusSoo Ki Kim0Takako Fujii1Soo Ryang Kim2Atsushi Nakai3Young-Suk Lim4https://orcid.org/0000-0002-1544-577XSatoru Hagiwara5Masatoshi Kudo6https://orcid.org/0000-0002-4102-3474Department of Gastroenterology, Kobe Asahi Hospital, Kobe, JapanDepartment of Gastroenterology, Kobe Asahi Hospital, Kobe, JapanDepartment of Gastroenterology, Kobe Asahi Hospital, Kobe, JapanDepartment of Gastroenterology, Kobe Asahi Hospital, Kobe, JapanDepartment of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, JapanDepartment of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, JapanBackground: Long-term therapy with nucleos(t)ide analogs (NAs) such as entecavir (ETV) and tenofovir disoproxil fumarate (TDF) favorably affects the incidence of hepatocellular carcinoma (HCC) on the basis of data from randomized or matched control studies. Recent data suggest a lower HCC incidence after 5 years of ETV or TDF therapy in chronic hepatitis B (CHB) patients, especially those with baseline cirrhosis. Summary: Three controversial issues remain to be resolved regarding hepatitis B virus (HBV) treatment and HCC. (1) The efficacy of antiviral treatment for the prevention of HCC is not established. The guidelines of the American Association for the Study of Liver Diseases (AASLD), the Asian Pacific Association for the Study of the Liver (APASL), and the European Association for the Study of the Liver (EASL) for the management of HBV infection state that antiviral treatment of HBV with interferon and NAs prevents the development of HCC. Among experts in CHB treatment, however, there is disagreement on the HCC prevention effects of antiviral treatment. (2) The rationale for antiviral management in patients with high HBV DNA and normal levels of alanine aminotransferase is unclear. The AASLD, EASL, and APASL guidelines do not recommend antiviral treatment for immune-tolerant CHB patients, and the terms and methods of treating such patients remain to be clarified. (3) The efficacy of first-line treatment with NAs, including ETV, TDF, and tenofovir alafenamide fumarate (TAF), to prevent HCC in CHB patients remains unknown. Several studies have produced controversial results regarding the effects of NAs on the risk and prevention of HCC. In the present review, we discuss these 3 issues, citing recent studies and clinical management guidelines from major international associations. Key Messages: Suggested approaches for reaching a consensus including applying the propensity score matching method, performing randomized controlled studies, and performing clinical studies with larger numbers of subjects and longer follow-up.https://www.karger.com/Article/FullText/525518hepatocellular carcinomahepatitis b virusimmune-tolerant phasenucleos(t)ide analogsalanine aminotransferase |
| spellingShingle | Soo Ki Kim Takako Fujii Soo Ryang Kim Atsushi Nakai Young-Suk Lim Satoru Hagiwara Masatoshi Kudo Hepatitis B Virus Treatment and Hepatocellular Carcinoma: Controversies and Approaches to Consensus Liver Cancer hepatocellular carcinoma hepatitis b virus immune-tolerant phase nucleos(t)ide analogs alanine aminotransferase |
| title | Hepatitis B Virus Treatment and Hepatocellular Carcinoma: Controversies and Approaches to Consensus |
| title_full | Hepatitis B Virus Treatment and Hepatocellular Carcinoma: Controversies and Approaches to Consensus |
| title_fullStr | Hepatitis B Virus Treatment and Hepatocellular Carcinoma: Controversies and Approaches to Consensus |
| title_full_unstemmed | Hepatitis B Virus Treatment and Hepatocellular Carcinoma: Controversies and Approaches to Consensus |
| title_short | Hepatitis B Virus Treatment and Hepatocellular Carcinoma: Controversies and Approaches to Consensus |
| title_sort | hepatitis b virus treatment and hepatocellular carcinoma controversies and approaches to consensus |
| topic | hepatocellular carcinoma hepatitis b virus immune-tolerant phase nucleos(t)ide analogs alanine aminotransferase |
| url | https://www.karger.com/Article/FullText/525518 |
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