Decreased incidence of hepatocellular carcinoma in non‐cirrhotic and low‐viral‐load chronic hepatitis B patients treated with nucleotide/nucleoside analogs

Abstract Nucleotide analogs (NAs) reduced hepatocellular carcinoma (HCC) incidence in chronic hepatitis B (CHB) patients. Among low‐viral‐load (DNA of hepatitis B virus [HBV] were <2000 IU/mL) and non‐cirrhotic CHB patients, the efficacy of NAs in the prevention of HCC remained elusive. The retrospective study recruited non‐cirrhotic CHB patients with hepatitis B e‐antigen (HBeAg) negative who were older than 50 years. Patients treated with or without NAs (2:1 age and sex match). HCC survey was performed during regular follow‐up. A total of 63 patients were recruited for the current study (mean age, 63.5 years; 61.9% male). All patients were non‐cirrhotic and with HBeAg negative. 68.3% of patients had fatty liver. Mean value of fibrosis‐4 index (FIB‐4) was 1.8. Overall, 65.1% of patients (41/63) were treated with potent NAs during the follow‐up period. Compared to patients without NAs therapy, those with NAs therapy had higher HBV DNA levels (416.0 IU/mL vs. 212.0 IU/mL; p = .01). The HCC development was substantially lower in patients with NAs therapy, compared to those without NAs therapy (0% vs. 9.1%; log‐rank p < .001). There was no HCC development in patients with NAs therapy, whereas two patients developed HCC within 2 years of follow‐up in patients without NAs therapy. NAs could reduce the incidence of HCC in older (more than 50 years), non‐cirrhotic, HBeAg‐negative patients with low viral load.