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. 2023 Jul 19;5(10):100852.
doi: 10.1016/j.jhepr.2023.100852. eCollection 2023 Oct.

On-treatment risks of cirrhosis and hepatocellular carcinoma among a large cohort of predominantly non-Asian patients with non-cirrhotic chronic hepatitis B

Zeyuan Yang  1 , Ramsey C Cheung  1   2 , Amit S Chitnis  3 , Wei Zhang  4 , Robert G Gish  5 , Robert J Wong  1   2
Affiliations

On-treatment risks of cirrhosis and hepatocellular carcinoma among a large cohort of predominantly non-Asian patients with non-cirrhotic chronic hepatitis B

Zeyuan Yang et al. JHEP Rep. .

Abstract

Background & aims: The vast majority of studies evaluating differences in on-treatment risks of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) have been conducted in Asia. Data on the course of CHB on antiviral therapy among predominantly non-Asian populations is less well described. We aimed to evaluate overall risks of cirrhosis and HCC and the influence of baseline factors on this risk among a predominantly non-Asian cohort of patients with CHB in the US.

Methods: Using longitudinal data from the national Veterans Affairs database, we evaluated the incidence of cirrhosis or HCC among adults with non-cirrhotic CHB on continuous antiviral therapy. Cumulative incidence functions and adjusted Cox proportional hazards models employed competing risks methods and evaluated overall risk and predictors of developing cirrhosis or HCC while on treatment.

Results: Among 2,496 patients with non-cirrhotic CHB (39.1% African American, 38.4% non-Hispanic White, 18.8% Asian, mean age 58.0 ± 13.4 years), the overall incidences of cirrhosis and HCC were 3.99 per 100 person-years (95% CI 3.66-4.35) and 0.43 per 100 person-years (95% CI 0.33-0.54), respectively. The highest incidences of cirrhosis and HCC were observed in non-Hispanic White patients (5.74 and 0.52 per 100 person-years, respectively), which were significantly higher than in Asian patients (1.93 and 0.17 per 100 person-years, respectively, p <0.0001). On multivariate regression, only baseline FIB-4 score was consistently associated with long-term risk of cirrhosis or HCC.

Conclusions: Using a longitudinal cohort of predominantly non-Asian Veterans with non-cirrhotic CHB on antiviral therapy (an understudied population), we provide important epidemiological data to describe long-term risks of cirrhosis and HCC.

Impact and implications: In one of the largest studies to date of a predominantly non-Asian cohort of patients with non-cirrhotic chronic hepatitis B, we provide important epidemiological data describing the long-term risks of cirrhosis and hepatocellular carcinoma among patients on antiviral therapies. Among this understudied population, the overall incidence of cirrhosis was 3.99 per 100-person-years (95% CI 3.66-4.35) and of HCC was 0.43 per 100-person-years (95% CI 0.33-0.54). These data also emphasize the importance of continued monitoring and HCC surveillance among CHB patients who are maintained on antiviral therapies.

Keywords: HBV; antivirals; cirrhosis; hepatocellular carcinoma; veterans.

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Conflict of interest statement

ZY, AC, and WZ report no disclosures. RGG reports grants received from Gilead Sciences; has served as an advisor or consultant to Abbot, AbbVie, Altimunne, Antios, Arrowhead, Dynavax, Eiger, Eisai, Enyo, Genentech, Genlantis, Gerson Lehrman Group, Gilead Sciences, Helios, HepaTX, HepQuant, Intercept, Janssen, Merck, Pfizer, Topography Health, Venatorx, Prodigy, Fibronostics, Fujifilm/Wako, Perspectum, Quest, Sonic Incytes; has served on the data safety monitoring board for Altimmune, Arrowhead, CymaBay Therapeutics, Durect; has served on the speaker’s bureau for AbbVie, BMS, Eisai, Genentech, Gilead Sciences Inc., Intercept; is a minor stock shareholder of RiboSciences, CoCrystal; has received stock options from Eiger, Genlantis, HepQuant, AngioCrine. RJW has received funding (to his institution) from Gilead Sciences and Exact Sciences, and has served as a consultant for Gilead Sciences. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Incidence of cirrhosis stratified by FIB-4 score and by race/ethnicity. FIB-4, fibrosis-4.
Fig. 2
Fig. 2
Incidence of HCC stratified by FIB-4 score and by race/ethnicity. FIB-4, fibrosis-4; HCC, hepatocellular carcinoma.
See this image and copyright information in PMC

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