Brief Article
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World J Gastroenterol. Dec 7, 2013; 19(45): 8373-8381
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8373
Antiviral drug resistance increases hepatocellular carcinoma: A prospective decompensated cirrhosis cohort study
Lei Li, Wei Liu, Yu-Han Chen, Chun-Lei Fan, Pei-Ling Dong, Fei-Li Wei, Bing Li, De-Xi Chen, Hui-Guo Ding
Lei Li, Yu-Han Chen, Chun-Lei Fan, Pei-Ling Dong, Bing Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You’an Hospital Affiliated with Capital Medical University, Beijing 100069, China
Wei Liu, Department of Internal Medicine, Beijing Ji Shui Tan Hospital Affiliated with Peking University, Beijing 100035, China
Fei-Li Wei, De-Xi Chen, Viral Laboratory of Liver Diseases Research Institute, Capital Medical University, Beijing 100069, China
Author contributions: Li L, Liu W and Chen YH equally contributed to the data collection and follow-up of patients in this study; Li L and Ding HG analysed the data and wrote the manuscript; Wei FL and Chen DX supervised the drug resistance mutation detection; Ding HG was responsible for this project and the final manuscript; the other authors contributed to the data acquisition and patient care.
Supported by The Major Projects on Infectious Disease, No. 2012ZX10002-008-005; the Beijing Science and Technology Commission Research Projects, No. H010210110129, Z111107058811067; and the High-level Talent Academic Leader Training Program, No.2011-2-19
Correspondence to: Hui-Guo Ding, MD, PhD, Director, Department of Gastroenterology and Hepatology, Beijing You’an Hospital Affiliated with Capital Medical University, Fengtai district, Beijing 100069, China. dinghuiguo@medmail.com.cn
Telephone: +86-10-83997155 Fax: +86-10-63295525
Received: July 24, 2013
Revised: September 22, 2013
Accepted: September 29, 2013
Published online: December 7, 2013
Processing time: 146 Days and 12.7 Hours
Abstract

AIM: To study the clinical outcome of antiviral therapy in hepatitis B-related decompensated cirrhotic patients.

METHODS: Three hundred and twelve patients with decompensated hepatitis B cirrhosis were evaluated in a prospective cohort. With two years of follow-up, 198 patients in the group receiving antiviral therapy with nucleos(t)ide analogues and 39 patients in the control group without antiviral treatment were analysed.

RESULTS: Among the antiviral treatment patients, 162 had a complete virological response (CVR), and 36 were drug-resistant (DR). The two-year cumulative incidence of hepatocellular carcinoma (HCC) in the DR patients (30.6%) was significantly higher than that in both the CVR patients (4.3%) and the control group (10.3%) (P < 0.001). Among the DR patients in particular, the incidence of HCC was 55.6% (5/9) in those who failed rescue therapy, which was extremely high. The rtA181T mutation was closely associated with rescue therapy failure (P = 0.006). The Child-Pugh scores of the CVR group were significantly decreased compared with the baseline (8.9 ± 2.3 vs 6.0 ± 1.3, P = 0.043).

CONCLUSION: This study showed that antiviral drug resistance increased the risk of HCC in decompensated hepatitis B-related cirrhotic patients, especially in those who failed rescue therapy.

Keywords: Hepatitis B; Decompensated cirrhosis; Nucleos(t)ide analogues; Hepatocellular carcinoma; Drug resistance

Core tip: This study was performed to analyse the clinical data of 312 patients with decompensated hepatitis B cirrhosis in a prospective cohort. These data showed that complete virological response could improve the clinical outcome in decompensated hepatitis B cirrhotic patients. However, clinicians should be aware of the high risk of hepatocellular carcinoma and liver failure in antiviral drug-resistant patients.