Nucleos[t]ide analogues (NUCs) treatment in HBe-negative chronic hepatitis B (CHB) patients would maintain a similar virologic and biochemical state compared to inactive hepatitis. And, sustained reduction of hepatitis B viral load by NUCs is helpful in lowering the risk of HCC. The purpose of this study was to evaluate the cumulative incidence of hepatocellular carcinoma (HCC) and death/transplantation in patients with inactive patients compared with HBeAg-negative CHB patients treated with NUCs.Methods
We performed a retrospective analysis of data from 3202 consecutive adult patients with non-cirrhotic CHB, inactive hepatitis (n=2,677) and HBeAg-negative hepatitis treated with NUCs between January 2000 and December 2013. Data were collected from patients for median 5.4 years and analysed by a multivariable Cox proportional hazards model for the entire cohort and propensity score-matched cohort.Results
During the study period, 127 (4.0%) developed HCC, 156 (4.8%) died or received transplantation. The annual risk of developing HCC and death/transplantation of inactive hepatitis and NUC treated HBeAg-negative hepatitis were 0.49% vs. 1.60% (hazard ratio [HR], 3.36; 95% confidence interval [CI], 1.20–4.82; p<0.001) and 0.77 vs. 0.80 (HR, 1.16, 95% CI 0.76–1.78, p<0.61), respectively. Multivariable analyses showed that compared with treated group, inactive hepatitis was associated with a significantly lower risk of HCC (HR, 0.43; 95% CI, 0.29–0.64; p<0.001), but a similar risk of death/transplantation (HR, 0.95; 95% CI, 0.61–1.49; p=0.82). In the propensity score-matched cohort (469 Pairs), inactive hepatitis was associated with a significantly lower risk of HCC (HR, 0.35; 95% CI, 0.18–0.65; p=0.001) but a similar risk of death/transplantation (HR, 1.20; 95% CI, 0.68–2.11; p=0.54). And the proportion of NUC treatment in inactive hepatitis was actually low (Estimated annual rate=0.87%).Conclusions
Inactive hepatitis develops significantly fewer HCCs compared to HBeAg-negative CHB hepatitis treated with NUCs with similar biochemical and virologic profile. In the NUC era, inactive hepatitis could be still evaluated as stable enough in the area where genotype C is dominant.