Patients with HDV infection and advanced fibrosis/cirrhosis present a high but predictable risk of developing hepatocellular carcinoma
AASLD LiverLearning®. Gaeta G. Nov 14, 2016; 144670
Topic: Hepatitis B
Label: Hepatitis B: Epidemiology & Natural History
Prof. Giovanni Gaeta
Prof. Giovanni Gaeta

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TITLE: Patients with HDV infection and advanced fibrosis/cirrhosis present a high but predictable risk of developing hepatocellular carcinoma

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Patients with Hepatitis Delta Virus (HDV) infection are at high risk for liver disease progression.The present study reports the rate of hepatocellular carcinoma (HCC) in a cohort of patients with HDV infection and advanced liver disease, while treated with anti-HBV analogues.
Methods. Caucasian patients with advanced liver fibrosis/cirrhosis who started entecavir or tenofovir treatment due to ongoing HBV replication were enrolled prospecively; excluded were patients with HCC, alcohol use, HIV or HCV. US surveillance was performed at 4-6 months intervals; HCC diagnosis was confirmed by CT or MR. Controls were HBV monoinfected patients, matched 1:1 by age, gender, platelet count, serum albumin and bilirubin levels. The primary endpoint of the analysis was the development of HCC.
Results. Enrolled were 56 caucasian patients with chronic HDV infection (age 52.5±8.5; 73.2 % males; 81% with cirrhosis; 5 HBeAg positive), pair matched with 56 HBV monoinfected patients.Follow-up was 50 months (range 6-168). All patients achieved HBV suppression. HCC was diagnosed in 17 (30.4%) HDV patients and in 6 (10,7%) controls (OR=3.63; 95% C.I. 1.30-10.07; p=0.018), with an estimate rate of 7.2% and 2.5% /year, respectively (Figure). In multivariable Cox regression model, male gender,age,baseline platelet count and HDV infection were associated to HCC. Using the model of the Page-B score1 and attributing 2 points to the presence of HDV infection, for a score>10 points a positive predictive value of 46.67% (95% CI= 8.34-65.67) and a negative predictive value of 88.46% (95% CI= 79.61-98.43) for HCC risk at 5 years was obtained.
Conclusions. HCC is a frequent endpoint in patients with HDV infection and advanced fibrosis/cirrhosis under tenofovir or entecavir. A modified Page-B score (Page-BD score) is a promising tool for selecting subjects at a lower 5-year risk of HCC .
1Papatheodoridis G et al, J Hepatol, 2016; 64:800-6

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