Rapid Alanine Aminotransferase Normalization with Entecavir and Hepatocellular Carcinoma in Hepatitis B Virus-Associated Cirrhosis

Eui Joo Kim, Jong Eun Yeon, Oh Sang Kwon, Heon Nam Lee, Seung Kak Shin, Seong Hee Kang, Kwan Soo Byun, Jeong Han Kim, So Young Kwon, Sang Jun Suh, Hyung Joon Yim, Yun Soo Kim, Ju Hyun Kim

    Research output: Contribution to journalArticlepeer-review

    7 Citations (Scopus)

    Abstract

    Background: Sustained abnormal serum alanine aminotransferase (ALT) levels can increase the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. Aim: This study is aimed to confirm the impact of rapid ALT normalization (≤30 IU/L) on HCC risk in patients with hepatitis B virus (HBV)-associated cirrhosis after entecavir (ETV) commencement. Methods: A total of 578 treatment-naïve patients with HBV-associated cirrhosis (mean age 51 ± 9 years, male sex 63.3%) were treated with ETV for more than 1 year. Serum ALT and HBV DNA levels were measured at three time points (baseline, 6, and 12 months after ETV commencement) and subjected to risk factor analysis. Results: Median follow-up after ETV commencement was 43 (12–98) months. Cumulative incidences of HCC at 1, 3, 5, and 7 years were 0.3, 8.5, 19.5, and 30.6%, respectively. Univariate Cox regression analysis showed that older age, abnormal ALT at 6 months or 12 months, and lower platelet count were significant risk factors for HCC. However, gender, HBeAg positivity, abnormal ALT levels or HBV DNA levels at baseline, and detectable HBV DNA at 6 or 12 months were not risk factors. Multivariate analysis showed that older age (P < 0.001), abnormal ALT at 12 months (P = 0.006), and lower platelet count (P = 0.034) were the risk factors for HCC. Conclusions: Abnormal serum ALT levels after ETV commencement are significant risk factor for HCC. Therefore, ALT should be rapidly normalized to minimize the risk of HCC development in patients with HBV-associated cirrhosis.

    Original languageEnglish
    Pages (from-to)808-816
    Number of pages9
    JournalDigestive Diseases and Sciences
    Volume62
    Issue number3
    DOIs
    Publication statusPublished - 2017 Mar 1

    Keywords

    • Alanine aminotransferase
    • Cirrhosis
    • Entecavir
    • Hepatitis B virus
    • Hepatocellular carcinoma

    ASJC Scopus subject areas

    • Physiology
    • Gastroenterology

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