Page 19 - Read Online

Review

Role of antiviral therapy in patients with chronic hepatitis B

or C virus in preventing the development of hepatocellular
carcinoma

1
1
1
1
Laura Scribano , Veronica Vanin , Giorgia Gottardo , Diana Sacchi , Francesco Paolo
Russo 1,2
1 Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterolog y, Padova University Hospital, 35128 Padova, Italy
2 Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, 35128 Padova,
Italy

ABSTRACT
Patients with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are at significant risk for hepatocellular
carcinoma (HCC). The most important risk factor associated with HCC is liver cirrhosis, which is again predominantly
caused by chronic HBV or HCV infection. The most effective approach to avoid HCC development is to prevent HBV
and HCV infection through vaccination. Indeed, HBV vaccine is the first vaccine demonstrated to prevent cancers.
However, a vaccine for HCV is not available. Thus, the prevention of HCV-related HCC and to a large extent HBV-
related HCC (among persons who are already chronically infected) will rely on antiviral therapy to prevent progressive
liver disease. The evidence that these patients can effectively be protected against HCC risk by the treatment with
antiviral therapy is rather controversial, due to the lack of randomized controlled trials (RCTs) that are ideally needed
to establish the effi cacy, but are logistically and ethically challenging. Although the strongest evidence to support that
antiviral therapy can prevent HCC should be derived from RCTs with HCC as an endpoint, it should be emphasized
that clinical trials showing the efficacy of antiviral therapy on virus suppression or eradication, and/or improvement in
liver histology can be considered indirect evidence that antiviral therapy can prevent HCC because high virus levels (in
the case of HBV infection) and cirrhosis (in both HBV and HCV infection) are the most important risk factors for HCC.

Key words: Antiviral therapy; cirrhosis; hepatitis B virus; hepatitis C virus; hepatocellular carcinoma; nucleos(t)ide
analogs; pegylated interferon; ribavirin

Address for correspondence:
Dr. Francesco Paolo Russo, Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via
Giustiniani 2, 35128 Padua, Italy. E-mail: francescopaolo.russo@unipd.it
Received: 25-02-2015, Accepted: 06-09-2015

INTRODUCTION hepatitis C virus (HCV). This population is constantly
[1]
exposed to an increased risk of developing cirrhosis,
The World Health Organization estimates that over 350 hepatocellular carcinoma (HCC), liver decompensation,
million persons are infected with hepatitis B virus (HBV)
and about 250 million people are chronically infected with This is an open access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non-commercially, as long as the
Access this article online author is credited and the new creations are licensed under the identical terms.
Quick Response Code
Website: For reprints contact: service@oaepublish.com
http://hr.oaepublish.com/ How to cite this article: Scribano L, Vanin V, Gottardo G,
Sacchi D, Russo FP. Role of antiviral therapy in patients with
DOI: chronic hepatitis B or C virus in preventing the development of
10.4103/2394-5079.168961 hepatocellular carcinoma. Hepatoma Res 2016;2:10-7.

10 © 2016 Hepatoma Research | Published by OAE Publishing Inc.