Managing hepatitis B to prevent liver cancer: recent advances

Abstract

Chronic hepatitis B (CHB) infection is a major cause of human mortality worldwide. The majority of people with CHB are infected early in life, and 20–40% of men and 15% of women with chronic infection will develop hepatocellular carcinoma (HCC). Antiviral therapy is recommended for patients with CHB who have cirrhosis or active disease with the aims of reducing disease progression to cirrhosis, liver failure and liver cancer, thereby preventing death. Evidence that treatment with interferon or with early nucleos(t)ide analogue therapy reduces HCC has been somewhat conflicting, however evidence is emerging to support a significant role in HCC prevention of the more effective antivirals, entecavir and tenofovir. Older patients, those with cirrhosis, and those undergoing curative treatments for HCC derive the greatest medium-term benefit in terms of HCC reduction, but HCC can still occur and long-term surveillance is recommended.

Keywords::

• cirrhosis
• entecavir
• hepatitis B
• hepatocellular carcinoma
• interferon
• tenofovir

Financial & competing interests disclosure

S Strasser has served on advisory boards and has received honoraria from Roche, Bristol Myers Squibb and Gilead Sciences. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Chronic hepatitis B (CHB) is a major cause of morbidity and mortality globally.

• The majority of CHB infections in the world were acquired at birth or in early childhood and 25–40% of those with CHB will die as a consequence of liver failure or hepatocellular carcinoma (HCC).

• Antiviral treatment with either pegylated interferon or oral nucleos(t)ide is indicated in patients with cirrhosis or active hepatitis at risk of disease progression.

• Therapy-associated viral suppression is associated with improved clinical outcomes including reduced fibrosis progression, regression of cirrhosis and reduced incidence of HCC.

• Antiviral therapy after curative management of HCC reduces late tumor recurrence.

• Patients with cirrhosis derive the greatest benefit in terms of improved clinical outcomes, but remain at risk of HCC, despite viral suppression and long-term treatment and surveillance are indicated.