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Tenofovir for chronic HBV reduces risk for hepatocellular carcinoma

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July 16, 2018

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Mindie H. Nguyen

In patients with chronic hepatitis B infection, treatment with tenofovir disoproxil may significantly reduce the risk for hepatocellular carcinoma, according to study findings published in The Journal of Infectious Diseases.

Among hundreds of patients included in the study, tenofovir disoproxil (TDF) was significantly associated with an 8-year hepatocellular carcinoma cumulative (HCC) incidence rate reduction among cirrhotic and non-cirrhotic patients, Mindie H. Nguyen, MD, MAS, AGAF, FAASLD, professor of medicine in the division of gastroenterology and hepatology at Stanford University Medical Center, and colleagues reported.

Chronic hepatitis B (CHB) affects approximately 250 million people worldwide,” Nguyen and colleagues wrote. “While mostly endemic to Asia and Africa, CHB is also prevalent in the United States among many immigrant groups and has been estimated by the National Health and Nutrition Examination Survey to affect approximately 0.8 to 1.4 million persons.”

According to the study, data concerning liver-related outcomes associated with TDF are limited in the Asian population. Nguyen and colleagues conducted a retrospective cohort study of 6,914 CHB monoinfected adults — older than 18 years — who had not undergone transplantation surgery from six U.S. referral, community medical centers from 2000 to 2016 and the Taiwan community-based REVEAL-HBV cohort.

Initially, 774 patients received TDF therapy, whereas 6,140 were untreated. Nguyen and colleagues balanced the groups using age, sex, hepatitis B e-antigen, HBV DNA, alanine aminotransferase (ALT), baseline cirrhosis state and follow-up time to match 591 patients in the treated and nontreated groups. After propensity score matching, the study population was on average 44.84 +/- 13.09 years old, 59.31% male and 95.43% Asian.

In the untreated group, Nguyen and colleagues determined that the 8-year cumulative HCC incidence was significantly higher at 20.13% compared with 4.69% in the treated group (P < 0.0001). According to the researchers, cirrhosis was a significant predictor for HCC (adjusted HR = 5.36; 95% CI, 2.73-10.51). When adjusting for age, sex, HBV DNA, ALT and study site, TDF therapy was associated with a 77% HCC risk reduction in patients with cirrhosis (aHR = 0.23; 95% CI, 0.56-0.92). Additionally, patients without cirrhosis receiving TDF had a 73% HCC risk reduction (aHR = 0.27; 95% CI, 0.07-0.98).

“This study clearly shows that the risk reduction occurred not in patients with cirrhosis but also in those without cirrhosis, a finding that was not seen consistently previously,” Nguyen told Infectious Disease News. “Further interventional research to improve linkage to care for CHB is needed, so at-risk patients can be identified, linked to care and initiated on therapy that has been shown to be beneficial.”– by Marley Ghizzone

Disclosures: Nguyen reports receiving research support from Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceutical, National Cancer Institute, Pfizer, B.K. Kee Foundation and Asian Health Foundation and serving as an advisory board member or consultant for Dynavax Laboratories, Gilead Sciences, Intercept Pharmaceuticals, Alnylam Pharmaceuticals, Bristol-Myers Squibb, Novartis and Janssen Pharmaceuticals. Please see the study for all other authors’ relevant financial disclosures.