Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;57(12):1407-1416.
doi: 10.1111/apt.17463. Epub 2023 Mar 28.

Long-term endoscopic surveillance in HBV compensated cirrhotic patients treated with Tenofovir or Entecavir for 11 years

Elisa Farina  1 , Alessandro Loglio  1 , Giulia Tosetti  1 , Elisabetta Degasperi  1 , Mauro Viganò  2 , Carmine Gentile  2   3 , Sara Monico  1 , Riccardo Perbellini  1 , Marta Borghi  1 , Floriana Facchetti  1 , Sara Colonia Uceda Renteria  4 , Ferruccio Ceriotti  4 , Federica Cerini  2 , Massimo Primignani  1 , Pietro Lampertico  1   3
Affiliations

Long-term endoscopic surveillance in HBV compensated cirrhotic patients treated with Tenofovir or Entecavir for 11 years

Elisa Farina et al. Aliment Pharmacol Ther. 2023 Jun.

Abstract

Background: Long-term administration of TDF/ETV in patients with HBV-related compensated cirrhosis reduces HCC and decompensation events but the effect of this regimen on development/regression of oesophageal varices (EV) is currently unknown.

Aim: To assess the risk of EV development/progression in this population.

Methods: A total of 186 Caucasian HBV-monoinfected compensated cirrhotics were enrolled in a long-term cohort study from TDF/ETV introduction. Upper GI endoscopies were performed according to Baveno recommendations. Primary endpoint was development/progression of oesophageal/gastric varices over time.

Results: At TDF/ETV start, median age was 61 years, 80% males, 60% HBV-DNA undetectable, 63% NUCs previously exposed, 73% normal ALT, 40% platelets <150,000/mmc and 25 (13%) with low-risk varices (LRV). During 11 years of antiviral therapy and 666 endoscopies performed, 9 patients either developed or had a progression of oesophageal or gastric varices with an 11-year cumulative probability of 5.1% (95% CI 3-10%); no patient bled. Out of 161 patients without EV at baseline, the 11-year probably was 4.5% with all varices developing within the first six years of treatment. In 25 patients with LRV at baseline, the 11-year probability of progression or regression was 9.3% and 58%, respectively. Only baseline platelet count (HR 0.96, p = 0.028) was associated with LRV development at multivariate analysis: platelet ≤90,000/mmc (AUROC 0.70) had 98.1% specificity, 42.9% sensitivity, 50% PPV for LRV onset.

Conclusions: In compensated cirrhotic patients under long-term effective TDF/ETV treatment, the 11-year risk of developing/progressing EV is negligible, thus challenging the current endoscopic surveillance recommendations in patients without EV at baseline.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. WHO reports. 2019 https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
    1. Lampertico P, Agarwal K, Berg T, Buti M, Janssen HLAG, et al. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67:370-98.
    1. Loglio A, Viganò M, Lampertico P. Novel therapies that may cure chronic hepatitis B virus. Clin Liver Dis. 2021;25:875-99.
    1. Roade L, Riveiro-Barciela M, Esteban R, Buti M. Long-term efficacy and safety of nucleos(t)ides analogues in patients with chronic hepatitis B. Ther Adv Infect Dis. 2021;8:2049936120985954.
    1. Marcellin P, Gane E, Buti M, Afdhal N, Sievert W, Jacobson IM, et al. Regression of cirrhosis during treatment with Tenofovir Disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study. Lancet. 2013;381:468-75.

Publication types

LinkOut - more resources