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Arch Hellen Med, 32(5), September-October 2015, 566-575


Can antiviral therapy in patients with chronic hepatitis B prevent the development of hepatocellular carcinoma?

L. Vasilieva, S.P. Dourakis
Second Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School,"Hippokration" General Hospital, Athens, Greece

Liver cancer is the fifth most common cancer worldwide. Hepatocellular carcinoma (HCC) represents >90% of primary liver cancers and is a major global health problem today. Chronic hepatitis B (CHB) is the leading cause of cirrhosis of the liver and of HCC, which has an annual incidence in patients with cirrhosis ranging from 2 to 5%. Older age, cirrhosis, and a high level of HBV DNA are the most important predictors of HCC in patients with CHB. Based on these parameters, a number of prediction scoring systems have been developed and validated in the community and clinical settings. Antiviral treatments such as nucleo(t)side analogues (NUCs) that may result in the regression of fibrosis and prevent clinical decompensation and variceal bleeding, often fail in the short term to prevent HCC. NUCs have been studied extensively in attempts at HCC prevention. A comprehensive review of the literature has shown that long term antiviral therapy with entecavir and tenofovir, which have potent antiviral activity and a low risk of drug resistance, is effective in suppressing HBV DNA and reducing but not eliminating the risk of HCC. In conclusion, NUCs can be safely and effectively used for the prevention of HCC. To attenuate HCC related outcomes, HBV replication must be permanently suppressed and HCC surveillance by 6-monthly abdominal ultrasound should be maintained even in patients with cirrhosis responding virologically, biochemically, clinically and histologically.

Key words: Chronic hepatitis B therapy, Hepatocellular carcinoma, Nucleos(t)ide analogues.

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