Perioperative Antivirals Reduce HBV Reactivation After Transarterial Chemoembolization

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Independent risk predictors for HBV reactivation in this study included HBeAg-positive status, more than 3 tumors, and absence of antiviral therapy.
Independent risk predictors for HBV reactivation in this study included HBeAg-positive status, more than 3 tumors, and absence of antiviral therapy.

Perioperative antiviral therapy may reduce the risk for hepatitis B virus (HBV) reactivation and improve liver function after transarterial chemoembolization (TACE) in patients with primary hepatocellular carcinoma (HCC), according to a study published in Medicine.1

TACE is currently the standard nonsurgical treatment for patients with intermediate- or advanced-stage HCC; however, HBV reactivation can occur following TACE, which may lead to fatal results including liver failure.2-5 It is unclear whether antiviral therapy reduces the risk for post-TACE HBV reactivation in patients who are negative for HBV DNA.1

Therefore, researchers in China prospectively evaluated 98 patients with HBV-related and HBV DNA-negative HCC who underwent TACE to study the effects of TACE combined with antiviral therapy.

Of these patients, 51 received entecavir 0.5 mg/day starting 3 days before TACE and for at least 1 month afterward. The rate of HBV reactivation and liver function was assessed before and after only 1 session of TACE, on average 1 month after the procedure.

The researchers found that HBV reactivation occurred in only 3 patients in the antiviral group but in 11 patients in the nonantiviral group (5.9% vs 23.4%, respectively; P < .05).

Independent risk predictors of HBV reactivation included hepatitis B envelope antigen-positive status, the presence of more than 3 tumors, and the absence of antiviral therapy. At 5 days after TACE, liver function did not differ significantly between the antiviral and nonantiviral groups.

However, the level of alanine aminotransferase and bilirubin were increased and albumin level was decreased in patients who experienced HBV reactivation compared with those who did not (P < .05).

At 1 month after TACE, liver function indicators did not differ significantly between patients who did and did not experience HBV reactivation.

“Initiation of antiviral therapy for patients before TACE significantly reduced the risk for HBV reactivation and protected liver function,” concluded the study authors.1

References

  1. Wang K, Jiang G, Jia Z, Zhu X, Ni C. Effects of transarterial chemoembolization combined with antiviral therapy on HBV reactivation and liver function in HBV-related hepatocellular carcinoma patients with HBV-DNA negative. Medicine (Baltimore). 2018;97(22):e10940.
  2. Leng JJ, Xu YZ, Dong JH. Efficacy of transarterial chemoembolization for hepatocellular carcinoma with portal vein thrombosis: a meta-analysis. ANZ J Surg. 2016;86:816-820.
  3. Lee JM, Jang BK, Lee YJ, et al. Survival outcomes of hepatic resection compared with transarterial chemoembolization or sorafenib for hepatocellular carcinoma with portal vein tumor thrombosis. Clin Mol Hepatol. 2016;22:160-167.
  4. Jang JW, Kwon JH, You CR, et al. Risk of HBV reactivation according to viral status and treatment intensity in patients with hepatocellular carcinoma. Antivir Ther. 2011;16:969-977. 
  5. Dan JQ, Zhang YJ, Huang JT, et al. Hepatitis B virus reactivation after radiofrequency ablation or hepatic resection for HBV-related small hepatocellular carcinoma: a retrospective study. Eur J Surg Oncol. 2013;39:865-872.
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