HBV antiviral treatment linked with reduced cirrhosis risk

Patients with chronic hepatitis B who received antiviral therapy experienced a significant reduction in risk for cirrhosis, according to study results.

“Few studies have specifically focused on the benefits of HBV antiviral therapies in non-Asian and noncirrhotic cohorts, especially as it relates to evaluating the impact of treatment on the risk of developing cirrhosis and death,” Robert J. Wong, MD, from Veterans Affairs Palo Alto Healthcare System, and colleagues wrote. “Furthermore, limited studies exist specifically focusing on safety-net and vulnerable populations, cohorts in whom it is particularly important to understand treatment benefits given existing disparities in timely access to HBV therapies and a disproportionately greater burden of advanced liver disease.”

Researchers analyzed data from 4,064 patients with chronic HBV from four safety-net health systems from 2010 to 2018. They evaluated the impact of HBV treatment on risk for cirrhosis, hepatocellular carcinoma, death, and composite of cirrhosis, HCC or death.

In the patient cohort, more than 51% were women, 42% were aged younger than 45 years, 31.6% were Black, 26.7% were Asian and 26.7% were Hispanic. Additionally, 23.2% received HBV antiviral therapy and 76.8% did not.

In a propensity score-match cohort that included 428 patients who received treatment and 428 who did not, treatment for chronic HBV was associated with lower risk for cirrhosis (HR = 0.67; 95% CI, 0.46-0.92) and composite cirrhosis, HCC or death (HR = 0.67; 95% CI, 0.49-0.94). Researchers found that women had lower risk than men, while Black patients had lower risk than non-Hispanic white patients.

After stratifying patients by age, sex and ethnicity, Wong and colleagues found that Asian women aged younger than 45 years had the greatest benefit from antiviral treatment.

“Our propensity score–matched analysis of noncirrhotic CHB patients across four urban safety-net health systems demonstrated significant reductions in risk of liver-related outcomes as a result of HBV antiviral therapies, driven primarily by the decreased risk of incident cirrhosis,” they wrote. “Although our study also demonstrated that the antiviral benefit was primarily seen in [chronic HBV] patients who were younger than age 45 years, female, and of Asian ethnicity, these observations need to be further evaluated in studies with longer follow-up.”