Cirrhotic patients infected with hepatitis B virus who consumed large quantities of alcohol were at increased risk for hepatocellular carcinoma compared with patients with either hepatitis B virus or alcoholism in a recent study.
Researchers in Taiwan conducted a retrospective study of 966 patients with cirrhosis, including those with hepatitis B virus infection (HBV) and alcoholism (n=132), HBV infection (n=632) and alcoholism (n=202), between 2002 and 2009. Patients self-reported alcohol consumption on a questionnaire, and researchers defined heavy alcoholism as consumption of more than 80 g of alcohol daily for at least 5 years.
Patients were followed until 2011, with the primary endpoint being newly diagnosed hepatocellular carcinoma (HCC). Cirrhotic patients with HBV infection and alcoholism (28.8%) showed the greatest percentage of newly developed HCC after 6 months of follow-up compared with patients with HBV infection (15.8%) and those with alcoholism (10.4%). Ten-year cumulative incidence of HCC was greater in patients with concomitant HBV infection and alcoholism (52.8%) than those with HBV infection (39.8%) or alcoholism alone (25.6%) (P<.001). Likewise, the annual incidence of HCC was 9.9%, 4.1% and 2.1% for patients with HBV infection and alcoholism, HBV infection alone and alcoholism alone, respectively.
Using multivariate logistic regression, baseline serum HBV DNA levels (OR=16.8; 95% CI, 1.94-104), serum alpha-fetaprotein (OR=1.18; 95% CI, 1.01-1.38) and antiviral nucleos(t)ide analogues (NUC) therapy (OR=0.01; 95% CI, 0.01-0.62) were predictive of HCC for patients with HBV infection and heavy alcoholism.
“Elevated baseline serum HBV DNA was a strong predictor of HCC and antiviral NUCs therapy reduced the incidence of HCC in cirrhotic patients with HBV infection and alcoholism,” the researchers concluded. “Aggressive antiviral NUCs therapy should be considered in alcoholic cirrhosis with detectable serum HBV DNA in order to reduce the incidence of HCC.”