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HBV suppression leads to regression of varices in patients with cirrhosis

A majority of patients with cirrhosis who underwent nucleotide analog therapy for hepatitis B virus infection also experienced regression of pre-existing esophageal varices. Those who did not have esophageal varices had a lower risk for developing them de novo.

 “Given these clinical benefits, strategies of surveillance in pharmacologically suppressed HBV patients need to be refined with reference to timing of endoscopy,” the researchers wrote.

The study included 107 patients with hepatitis B e antigen-negative compensated cirrhosis who entered long-term protocol-based surveillance for esophageal varices after therapy with lamivudine. Patients with resistance to lamivudine received early add-on adefovir dipivoxil or switched to tenofovir disoproxil fumarate.

To determine the development and progression of esophageal varices (EV), EV progression was classified as the transition from F1 to F2 or F3 fibrosis or GI bleeding, with EV regression considered when there was no evidence of EV confirmed in two consecutive endoscopies.

Upper gastrointestinal endoscopies (n = 414) applied to those patients with cirrhosis over a median period of 12 years of therapy were included in the final analysis.

Overall, 27 patients had baseline F1 fibrosis with EV. Over the study period, EV regressed in 18 of these patients, EV remained unchanged in eight patients and EV progressed in one patient. The 12-year cumulative incidence of EV regression was 83% (95% CI, 52%–92%).

De novo F1 and F2 fibrosis and EV developed in six of 80 patients who had a 10% 12-year cumulative incidence rate for developing EV (95% CI, 5%-20%). Six of seven patients with de novo varices or progression of pre-existing varices experienced clinical breakthrough due to LMV resistance and/or developed hepatocellular carcinoma, according to the research.

Twelve patients died and 15 underwent transplants, most of them due to the development of HCC. The 12-year cumulative incidence rate for HCC was 33% (95% CI, 24%-42%) and overall survival was 76% (95% CI, 67%-83%). – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.