Prevention of hepatitis B virus–related hepatocellular carcinoma with antiviral therapy

Chronic hepatitis B (CHB) infection is the major cause of hepatocellular carcinoma (HCC). Primary prevention of hepatitis B infection by vaccination is effective in reducing the incidence of HCC. In persons with CHB infection, the two accepted treatment modalities are interferon alpha (IFN‐α) given subcutaneously for a limited period and nucleoside/nucleotide analogs given orally on a long‐term basis. These treatments are effective in suppressing viral activity and improving disease markers in short‐term studies. The long‐term effect on the development of liver cancers with these two forms of treatment appears to be different. However, there are no studies directly comparing IFN‐α and nucleoside/nucleotide analogs. Comparisons across studies are inevitably limited by differences in the baseline characteristics of the study cohorts. Long‐term follow‐up studies of IFN‐α therapy show inconsistent results. The beneficial effect in reducing the development of liver cancer is observed mainly in treatment responders who have preexisting cirrhosis of the liver. The long‐term studies of lamivudine (and adefovir) show a consistent reduction in the development of liver cancers in patients with, and without, cirrhosis. This beneficial effect is blunted by the development of resistance. The effects of the newer nucleoside/nucleotide analogs, with higher potency and minimal risk of resistance development, are, as yet, unknown. (HEPATOLOGY 2013)