Liver and Bile

Hepatology. 2023;78(5):1558–68

Huang DQ, Tran A, Yeh ML, Yasuda S, Tsai PC, Huang CF, Dai CY, Ogawa E, Ishigami M, Ito T, Kozuka R, Enomoto M, Suzuki T, Yoshimaru Y, Preda CM, Marin RI, Sandra I, Tran S, Quek SXZ, Khine HHTW, Itokawa N, Atsukawa M, Uojima H, Watanabe T, Takahashi H, Inoue K, Maeda M, Hoang JK, Trinh L, Barnett S, Cheung R, Lim SG, Trinh HN, Chuang WL, Tanaka Y, Toyoda H, Yu ML, Nguyen MH

Antiviral therapy substantially reduces HCC risk in patients with chronic hepatitis B infection in the indeterminate phase

Background and aims: Risk of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) is higher in the indeterminate phase compared with the inactive phase. However, it is unclear if antiviral therapy reduces HCC risk in this population. The authors aimed to evaluate the association between antiviral therapy and HCC risk in the indeterminate phase.
Approach and results: They analyzed 855 adult (59% male), treatment-naive patients with CHB infection without advanced fibrosis in the indeterminate phase at 14 centers (United States, Europe, and Asia). Inverse probability of treatment weighting (IPTW) was used to balance the treated (n = 405) and untreated (n = 450) groups. The primary outcome was HCC development. The mean age was 46 ± 13 years, the median alanine transaminase (ALT) was 38 U/l (interquartile range, 24–52), the mean HBV DNA was 4.5 ± 2.1 log10 IU/ml, and 20% were hepatitis B e antigen (HBeAg) positive. The 2 groups were similar after IPTW. After IPTW (n = 819), the 5-, 10-, and 15-year cumulative HCC incidence was 3%, 4%, and 9% among treated patients (n = 394) versus 3%, 15%, and 19%, among untreated patients (n = 425), respectively (p = 0.02), with consistent findings in subgroup analyses for age > 35 years, males, HBeAg positive, HBV DNA > 1000 IU/ml, and ALT < upper limit of normal. In multivariable Cox proportional hazards analysis adjusted for age, sex, HBeAg, HBV DNA, ALT, diabetes, and platelets, antiviral therapy remained an independent predictor of reduced HCC risk (adjusted hazard ratio = 0.3, 95% confidence interval: 0.1–0.6, p = 0.001).

Conclusions: Antiviral therapy reduces the risk of hepatocellular carcinoma by 70% among patients with indeterminate-phase chronic hepatitis B (CHB). These data have important implications for the potential expansion of CHB treatment criteria.

M.H. Nguyen, M.D., Professor of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA, E-Mail: mindiehn@stanford.edu

DOI: 10.1097/hep.0000000000000459

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Liver and Bile

Development, validation, and prognostic evaluation of a risk score for long-term liver-related outcomes in the general population: A multicohort study

Lancet. 2023;402(10406):988–96

Serra-Burriel M, Juanola A, Serra-Burriel F, Thiele M, Graupera I, Pose E, Pera G, Grgurevic I, Caballeria L, Piano S, van Kleef L, Reichert M, Roulot D, Pericàs JM, Schattenberg JM, Tsochatztis EA, Guha IN, Garcia-Retortillo M, Hernández R, Hoyo J, Fuentes M, Expósito C, Martínez A, Such P, Madir A, Detlefsen S, Tonon M, Martini A, Ma AT, Pich J, Bonfill E, Juan M, Soria A, Carol M, Gratacós-Ginès J, Morillas RM, Toran P, Navarrete JM, Torrejón A, Fournier C, Llorca A, Arslanow A, de Koning HJ, Cucchietti F, Manns M, Newsome PN, Hernáez R, Allen A, Angeli P, de Knegt RJ, Karlsen TH, Galle P, Wong VWS, Fabrellas N, Castera L, Krag A, Lammert F, Kamath PS, Ginès P; LiverScreen Consortium Investigators

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Liver and Bile

Risk of severe infection in patients with biopsy-proven non-alcoholic fatty liver disease – A population-based cohort study

Clin Gastroenterol Hepatol. 2023;21(13):3346–55.e19