HCC in HBeAg negative genotype D under nucs

[stef2011]

*TITLE: *Impact of liver fibrosis in development of hepatocellular
carcinoma in HBeAg negative genotype D patients with chronic hepatitis B
treated with nucleos(t)ide analogues.

*ABSTRACT BODY: *Background: Chronic hepatitis B (CHB) patients are at
increased risk for hepatocellular carcinoma (HCC). The effect of medium
and long term nucleos(t)ide analogue therapy (NUCs) on HCC incidence is
unclear.
Objective: To evaluate the predictors of HCC in HBeAg negative genotype
D CHB patients who received a long term treatment with NUCs.
Design: Retrospective and prospective analysis of HCC incidence in CHB
patients starting with NUCs for a duration >18 months.
Methods: Between January 1998 and December 2011 a total of 235 patients
with CHB were treated with NUCs for more than 18 months. The incidence
for HCC was examined after the start of NUCs and risk factors for liver
carcinogenesis were analyzed. The mean follow up period was 6.8 years.
Results: During a median follow up of 6.8+3.4 years HCC developed in 32
patients (13.6%). Hepatocellular carcinoma was disclosed in 15 over 120
patients treated with entecavir (12.5%), in 7 over 27 treated with
tenofovir (13.4%), in 6 over 7 treated with lamivudine (85.7%) in 4 over
18 (22.2%) treated with adefovir plus lamivudine and in no patients
treated with telbivudine (2 patients). The cumulative incidence of HCC
was higher in patients with cirrhosis than in those with CHB (35% vs.
2.5%). At univariate analysis the probability of developing HCC was
higher for: patients with compensated and decompensated cirrhosis
(p 60 (p<0.000001) and without a
virological response (p 60
years old treated with a long term NUCs therapy are at high risk of HCC
despite a virological response.

[veteranB]

With 50% chance to clear hbv vs1% on nucs I think this should be  the determining factor. So far the most effective immune therapy that is approved is interferon. That happens to be  an antiviral also.

[veteranB]

I suggest you also read the hiv forums on reported antiviral sides that now we have to deal with.

Drug resistant super virus hbv that develops  on these nucs that is another issue which is also important.

[calmama]

Not all interferon's side effects are reversible.  Autoimmune disorders caused by interferon use are usually not reversible.  The longer we use interferon (ie. more than one year), the higher chance to develop autoimmune problems (eg. autoimmune thyroid disorder, diabetes, rheumatoid arthritis, Crohn's, autoimmune hepatitis, etc).  Some of these autoimmune problems are not easy to control without taking immunosuppressants.  So interferon has its own serious side effects (some permanent) and is not for everyone.

I don't necessarily like taking an antiviral.  But so far the TDF+add-on 48-96-week-interferon treatment has NOT showed good cure rate for e-negative people with qHbsAg more than 1000 iu/ml (with the exception of maybe 2-3 cases, but that's 'the exception', not general).  The benefit of interferon treatment (especially the 96-week one) doesn't outweigh the risk for me at this moment.

[4est]

you support Veteran B argue on kidney problems and mutation caused by NUC's - please read the @ studyforhope explanation and argue again with other arguments if it is the case.

as far as I understand if we are disusing Tenofovir (for example) and we use vit D and resveratrol we have a good chance not to have any kidney problem, mutation and also to have a low HVB DNA and low risk of liver problems (do to HBV)

[4est]

I think you are a math / logic teacher / enthusiastic :).
I agree with you and your position regarding NUC's and also I support that some time, some thing should be say using tough words.

@Veteran: as I say fatty liver and high blood pressure cand be develop  also without NUC's or any other relation to NUC's so be careful when you put the blame.

Also do not put all NUC's in the same basket, @ studyforhope give us some precious information regarding NUC's and mutation and I think that were easily forgot because of our small fight.
Read again what @ studyforhope post (now ant also in past) and maybe we will have other point of view.


  

[Rome70]

The one who tells A False statement is not necessarily a lier.
And it is not up to anyone to be an ultimate judge here, one should just agree or disagree rather than accuse,  other wise it is a quarrel but not an argument.