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Jang, Tyng-Yuan; Wei, Yu-Ju; Liu, Ta-Wei; Yeh, Ming-Lun; Liu, Shu-Fen; Hsu, Cheng-Ting; Hsu, Po-Yao; Lin, Yi-Hung; Liang, Po-Cheng; Hsieh, Meng-Hsuan; Ko, Yu-Min; Tsai, Yi-Shan; Chen, Kuan-Yu; Lin, Ching-Chih; Tsai, Pei-Chien; Wang, Shu-Chi; Huang, Ching-I; Lin, Zu-Yau; Chen, Shinn-Cherng; Chuang, Wan-Long; Huang, Jee-Fu; Dai, Chia-Yen; Huang, Chung-Feng; Yu, Ming-Lung
Scientific reports, 04/2021, Letnik: 11, Številka: 1Journal Article
Hepatitis D virus (HDV) infection increases the risk of hepatocellular carcinoma (HCC) in the natural course of chronic hepatitis B (CHB) patients. Its role in patients treated with nucleotide/nucleoside analogues (NAs) is unclear. We aimed to study the role of hepatitis D in the development of HCC in CHB patients treated with NAs. Altogether, 1349 CHB patients treated with NAs were tested for anti-HDV antibody and RNA. The incidence and risk factors of HCC development were analyzed. Rates of anti-HDV and HDV RNA positivity were 2.3% and 1.0%, respectively. The annual incidence of HCC was 1.4 per 100 person-years after a follow-up period of over 5409.5 person-years. The strongest factor association with HCC development was liver cirrhosis (hazard ratio HR/95% confidence interval CI 9.98/5.11-19.46, P < 0.001), followed by HDV RNA positivity (HR/ CI 5.73/1.35-24.29, P = 0.02), age > 50 years old (HR/CI 3.64/2.03-6.54, P < 0.001), male gender (HR/CI 2.69/1.29-5.60, P: 0.01), and body mass index (BMI, HR/CI 1.11/1.03-1.18, P = 0.004). The 5-year cumulative incidence of HCC was 7.3% for patients with HDV RNA negativity compared to that of 22.2% for patients with HDV RNA positivity (P = 0.01). In the subgroup of cirrhotic patients, the factors associated with HCC development were HDV RNA positivity (HR/CI 4.45/1.04-19.09, P = 0.04) and BMI (HR/CI 1.11/1.03-1.19, P = 0.01). HDV viremia played a crucial role in HCC development in CHB patients who underwent NA therapy.
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