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Ayoub et al. Nucleos(t)ide therapy for hepatitis B impacts HCC incidence

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MS, Lin CY, Chiou ST, Kuo HS, Chen DS; Taiwan Hepatoma Study
trials already suggest that treatment with these NAs Group. Long-term effects of hepatitis B immunization of infants in
have chemopreventive effects and reduce risk of HCC. preventing liver cancer. Gastroenterology 2016;151:472-80.e1.
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Continued viral suppression is critical to minimize T, Tao QM, Shue K, Keene ON, Dixon JS, Gray DF, Sabbat J;
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which address the confounding factors such as 5. Kao JH, Liu CJ, Jow GM, Chen PJ, Chen DS, Chen BF. Fine
gender, age, fibrosis stage. Finally, HCC screening mapping of hepatitis B virus pre-S deletion and its association with
algorithms are necessary to better elucidate the impact hepatocellular carcinoma. Liver Int 2012;32:1373-81.
of chemoprevention on HCC development in HBV 6. Tseng TC, Liu CJ, Yang HC, Su TH, Wang CC, Chen CL, Kuo SF, Liu
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antigen increase risk of hepatocellular carcinoma in patients with low
HBV load. Gastroenterology 2012;142:1140-9.e3; quiz e13-4.
In summary, treatment of hepatitis B leads to 7. Moon JC, Kim SH, Kim IH, Lee CH, Kim SW, Lee SO, Lee ST, Kim
decreased incidence of hepatocellular carcinoma in DG. Disease progression in chronic hepatitis B patients under long-
Asians and Caucasians regardless of the nucleos(t)ide term antiviral therapy. Gut Liver 2015;9:395-404.
used. Also, decreasing the HBV viral load, regardless 8. Fattovich G, Bortolotti F, Donato F. Natural history of chronic
of achieving seroconversion, results in decreased hepatitis B: special emphasis on disease progression and prognostic
HCC incidence. Despite this reduction in HCC factors. J Hepatol 2008;48:335-52.
incidence, patients treated with nucleos(t)ides still 9. Raffetti E, Fattovich G, Donato F. Incidence of hepatocellular
carcinoma in untreated subjects with chronic hepatitis B: a systematic
need to undergo liver cancer screening. Several HCC review and meta-analysis. Liver Int 2016;36:1239-51.
predictor models have been developed, but as of now, 10. Marcellin P, Buti M, Krastev Z, de Man RA, Zeuzem S, Lou L,
there are limitations in applicability. Gaggar A, Flaherty JF, Massetto B, Lin L, Dinh P, Subramanian GM,
McHutchison JG, Flisiak R, Gurel S, Dusheiko GM, Heathcote EJ.
DECLARATIONS Kinetics of hepatitis B surface antigen loss in patients with HBeAg-
positive chronic hepatitis B treated with tenofovir disoproxil fumarate.
J Hepatol 2014;61:1228-37.
Authors’ contributions 11. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology
Project conception: W.S. Ayoub, P. Martin, P.D. Jones 2009;50:661-2.
Literature review, manuscript drafting and critical 12. Gish RG, Chang TT, Lai CL, de Man R, Gadano A, Poordad F, Yang
revision: W.S. Ayoub, F. Dailey, P. Martin, P.D. Jones J, Brett-Smith H, Tamez R. Loss of HBsAg antigen during treatment
with entecavir or lamivudine in nucleoside-naive HBeAg-positive
patients with chronic hepatitis B. J Viral Hepat 2010;17:16-22.
Financial support and sponsorship 13. Ayoub WS, Keeffe EB. Review article: current antiviral therapy of
None. chronic hepatitis B. Aliment Pharmacol Ther 2011;34:1145-58.
14. Triolo M, Della Corte C, Colombo M. Impact of HBV therapy on the
Conflicts of interest incidence of hepatocellular carcinoma. Liver Int 2014;34 Suppl 1:139-
Walid S. Ayoub, Francis Dailey, Paul Martin, Patricia D. 45.
Jones declare that they have no conflicts of interest. 15. Liu F, Wang XW, Chen L, Hu P, Ren H, Hu HD. Systematic review
with meta-analysis: development of hepatocellular carcinoma
in chronic hepatitis B patients with hepatitis B surface antigen
Patient consent seroclearance. Aliment Pharmacol Ther 2016;43:1253-61.
Not applicable. 16. Sung JJ, Tsoi KK, Wong VW, Li KC, Chan HL. Meta-analysis:
treatment of hepatitis B infection reduces risk of hepatocellular
Ethics approval carcinoma. Aliment Pharmacol Ther 2008;28:1067-77.
This article does not contain any studies with human 17. Papatheodoridis GV, Lampertico P, Manolakopoulos S, Lok A.
or animal subjects performed by any of the authors. Incidence of hepatocellular carcinoma in chronic hepatitis B patients
receiving nucleos(t)ide therapy: a systematic review. J Hepatol
2010;53:348-56.
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impact of oral anti-viral agents on the incidence of hepatocellular
carcinoma in chronic hepatitis B. Aliment Pharmacol Ther
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