DECLINES in serum hepatitis B virus (HBV) RNA during the first and second year of treatment with nucleoside analogues (NA) could be strong indicators of reduced risk for hepatocellular carcinoma (HCC), according to recently published research. Previous studies have found that serum HBV RNA levels were significantly associated with HCC risk, which the study authors commented “suggests the need to consider this novel viral marker when evaluating the HCC risk in the treated population.”
The research team enrolled 1,374 patients from two chronic HBV cohorts to measure their serum HBV RNA levels over three years of NA treatment. At the start, the median HBV RNA level was 4.3 log10 copies/mL. After a median follow-up of 5.4 years, 76 patients developed HCC, translating to a 5-year cumulative incidence of 4%. The study found that HBV RNA declines at 1 year (adjusted HR [aHR] = 0.7) and 2 years (aHR = 0.71) were independently associated with lower HCC risk. The team did note, however, that while NA treatments like entecavir and tenofovir disoproxil fumarate significantly reduce the risk of HCC, they do not eliminate it.
Patients who experienced greater reductions in HBV RNA had a significantly lower risk of developing HCC. Their 5-year HCC incidence rates were 3.4% at 1 year and 4.9% at 2 years, compared to 7.3% and 9.2%, respectively, in patients with less RNA reduction.
The authors concluded that incorporating early HBV RNA declines into existing risk models could improve HCC prediction in the future, and guide more effective cancer surveillance strategies in patients with chronic HBV.
Victoria Antoniou, EMJ
Reference
Liu S et al. Role of early on-treatment serum HBV RNA declines in predicting hepatocellular carcinoma risk in patients with chronic hepatitis B. Clin Gastroenterol Hepatol. 2024:S1542-3565(24)00758-4.
