ANTIVIRAL THERAPY DOES NOT IMPROVE OUTCOMES OF PATIENTS WITH HEPATITIS B VIRUS-RELATED DECOMPENSATED CIRRHOSIS AND UNDETECTABLE DNA

초록

Background: Antiviral therapy (AVT) is the mainstay of hepatitis B virus (HBV) management. We investigated whether AVT improves the outcomes of patients with HBV-related decompensated cirrhosis and undetectable HBV DNA. Methods: Between 2000 and 2017, treatment-naïve patients with HBV-related decompensated cirrhosis and undetectable HBV DNA were recruited from two tertiary hospitals. The endpoints included death or orthotopic liver transplantation (OLT) and hepatocellular carcinoma (HCC). Results: A total of 429 patients were analyzed (50 and 379 patients in the AVT and Non-AVT groups, respectively). Patients in the AVT group were significantly younger and had significantly higher alanine aminotransferase and alpha-fetoprotein levels than those in the non-AVT group (all P<0.05). During the follow-up period (median 49.6 months), 98 patients died, 40 underwent OLT, and 105 developed HCC. The cumulative incidence rates of death or OLT (2.0%, 8.1%, and 10.3% vs. 7.9%, 11.4%, and 14.8% at 6 months, 1 year, and 2 years, respectively) and HCC (8.6%, 15.8%, and 26.4% vs. 1.6%, 7.7%, and 24.4% at 1 year, 2 years, and 5 years, respectively) were statistically comparable between the AVT and non-AVT groups (all P>0.05). Using Cox regression analysis, AVT was not significantly associated with death or OLT, nor HCC (all P>0.05). Similar results were observed in the propensity score-matched AVT (n=50) and non-AVT (n=50) groups. In the non-AVT group, the cumulative incidence rate of HBV DNA detection at 6 months, 1 year, and 2 years were 2.0%, 3.1%, and 6.4%, respectively. The cumulative incidence rates of death or OLT (3.8%, 7.9%, and 10.2% vs. 8.6%, 11.9%, and 15.5% at 6 months, 1 year, and 2 years, respectively) and HCC (2.2%, 7.1%, and 35.0% vs. 1.5%, 7.8%, and 22.3% at 1 year, 2 years, and 5 years, respectively) were statistically comparable between patients who experienced HBV DNA detection and those who did not (all P>0.05). Using Cox regression analysis, HBV DNA detection was not significantly associated with death or OLT, nor HCC (all P>0.05). Conclusion: AVT did not attenuate the risk of death or OLT and HCC development in patients with HBV-related decompensated cirrhosis and undetectable HBV DNA. In addition, because the rate of HBV DNA detection was not negligible in this study population, close monitoring might be required for appropriate AVT initiation.