| Invited Lecture(JSGE) |
| Fri. November 1st 14:30 - 15:00 Room 9: Portopia Hotel Main Building Kairaku 3 |
| Simplified treatment criteria for chronic hepatitis B to prevent hepatocellular carcinoma | |||
| Young-Suk Lim | |||
| Asan Medical Center, University of Ulsan College of Medicine | |||
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| We found that the association between baseline serum HBV DNA levels and HCC risk is not linear but parabolic in non-cirrhotic, untreated, adult CHB patients with no significant ALT level elevation.1 The HCC risk was highest at moderate HBV DNA levels around 6 log10 IU/mL, with decreasing HCC risk at higher and lower HBV DNA levels. Our additional studies have demonstrated that the level of serum HBV DNA at baseline impacts the on-treatment risk of HCC in non-cirrhotic patients with CHB during long-term NUC treatment.2-4 We found that patients with moderate baseline viral load, particularly around 6 log10 IU/mL, demonstrated the highest on-treatment HCC risk, despite long-term antiviral treatment. Compared with the matched untreated patients, the treated patients in the high and moderate viral load groups had a significantly lower risk of HCC. Nonetheless, the reduced risk of the treated patients in the moderate viral load group was significantly higher than that of the treated patients in the high viral load group. Initiating antiviral treatment at either high (≥8.00 log10 IU/mL) or low (3.30-4.99 log10 IU/mL) viral loads was associated with a significantly lower on-treatment risk of HCC compared to starting the treatment at a moderate baseline viral load (5.00-7.99 log10 IU/mL). Therefore, early initiation of antiviral treatment with a high viral load (≥8.00 log10 IU/mL) or low viral load (3.30-4.99 log10 IU/mL) may maintain the lowest long-term risk of HCC in non-cirrhotic adult CHB patients regardless of ALT levels. References 1. Kim GA, Han S, Choi GH, et al. Moderate levels of serum hepatitis B virus DNA are associated with the highest risk of hepatocellular carcinoma in chronic hepatitis B patients. Aliment Pharmacol Ther 2020;51:1169-1179. 2. Choi WM, Kim GA, Choi J, et al. Increasing on-treatment hepatocellular carcinoma risk with decreasing baseline viral load in HBeAg-positive chronic hepatitis B. J Clin Invest 2022;132:e154833. 3. Choi WM, Yip TC, Kim WR, et al. Chronic Hepatitis B baseline viral load and on-treatment liver cancer risk: A multinational cohort study of HBeAg-Positive patients. Hepatology 2024:ePub ahead of print. 4. Choi WM, Kim GA, Choi J, et al. Non-linear association of baseline viral load with on-treatment hepatocellular carcinoma risk in chronic hepatitis B. Gut 2024;73:649-658. |
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