The long-term benefits of nucleos(t)ide analogs in compensated HBV cirrhotic patients with no or small esophageal varices: A 12-year prospective cohort study

详细信息    查看全文

• 作者：Pietro Lampertico¹ ; Federica Invernizzi¹ ; Mauro Viganò ; ² ; Alessandro Loglio¹ ; Giampaolo Mangia¹ ; Floriana Facchetti¹ ; Massimo Primignani¹ ; Manol Jovani¹ ; Massimo Iavarone¹ ; Mirella Fraquelli³ ; Giovanni Casazza⁴ ; Roberto de Franchis⁵ ; Massimo Colombo¹ ; ^{massimo.colombo@unimi.it" class="auth_mail" title="E-mail the corresponding author}
• 关键词：EV ; esophageal varices ; NUC ; nucleos(t)ide analogs ; GI ; gastrointestinal ; LMV ; lamivudine ; LMV-R ; lamivudine resistance ; HCC ; hepatocellular carcinoma ; HBV ; hepatitis B virus ; HVPG ; hepatic venous pressure gradient ; EGDS ; esophago-gastroduodenoscopy ; PHG ; portal hypertensive gastropathy ; GOV ; gastro-esophageal varices ; IGV ; isolated gastric varices ; LT ; liver transplantation ; RWM ; red wale marks ; HIV ; human immunodeficiency virus ; US ; abdominal ultrasound
• 刊名：Journal of Hepatology
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：63
• 期：5
• 页码：1118-1125
• 全文大小：731 K

文摘

Esophageal varices (EV) are a marker of disease severity in compensated cirrhosis due to hepatitis B virus (HBV) which predicts also the risk of hepatocellular carcinoma (HCC), clinical decompensation and anticipated liver related death. The dynamics and prognostic significance of EV in patients under long-term HBV suppression by nucleos(t)ide analogs (NUC), are poorly known.

Methods

A standardized protocol (Baveno) including 414 upper gastrointestinal (GI) endoscopies was applied to 107 HBeAg-negative compensated cirrhotic patients (93% Child-Pugh A) during a median of 12 (range 2 to 17) years of NUC therapy. Patients who initially started on lamivudine (LMV) and then developed resistance (LMV-R), were rescued by early administration of adefovir, or were switched to tenofovir. Surveillance included serum HBV DNA every three months and abdominal ultrasound every six months.

Results

Twenty-seven patients had baseline F1 EV which regressed in 18, remained unchanged in eight and progressed in one patient; the 12-year cumulative incidence of EV regression was 83% (95% CI: 52–92%). De novo F1/F2 EV developed in 6/80 patients with a 12-year cumulative incidence of 10% (95% CI: 5–20%). Six of seven patients with de novo varices or progression of pre-existing varices had either a clinical breakthrough due to LMV-R and/or developed a HCC. No bleedings from ruptured EV occurred, 12 patients died (9 HCC) and 15 were transplanted (13 HCC): the 12-year cumulative incidence of HCC and overall survival was 33% (95% CI: 24–42%) and 76% (95% CI: 67–83%), respectively.

Conclusions

Long-term pharmacological suppression of HBV in HBeAg-seronegative patients with compensated cirrhosis leads to a significant regression of pre-existing EV accompanied by a negligible risk of developing de novo EV.