Persistent risk for new, subsequent new and recurrent hepatocellular carcinoma despite successful anti-hepatitis B virus therapy and tumor ablation: The need for hepatitis B virus cure.

Authors

Brianna J. Shinn, Thomas Jefferson UniversityFollow
Aaron Martin, Thomas Jefferson UniversityFollow
Robert M. Coben, Thomas Jefferson UniversityFollow
Mitchell I. Conn, Thomas Jefferson UniversityFollow
Jorge Prieto, Thomas Jefferson UniversityFollow
Howard Kroop, Thomas Jefferson UniversityFollow
Anthony J. DiMarino, Thomas Jefferson UniversityFollow
Hie-Won Hann, Thomas Jefferson UniversityFollow

Document Type

Article

Publication Date

1-27-2019

Comments

This article has been peer reviewed. It is the author’s final published version in World Journal of Hepatology, Volume 11, Issue 1, January 2019, Pages 65-73.

The published version is available at https://doi.org/10.4254/wjh.v11.i1.65. Copyright © Shinn et al.

Abstract

Hepatitis B virus (HBV) is one of the most significant hepatocarcinogens. The ultimate goal of anti-HBV treatment is to prevent the development of hepatocellular carcinoma (HCC). During the last two decades, with the use of currently available anti-HBV therapies (lamivudine, entecavir and tenofovir disoproxil fumatate), there has been a decrease in the incidence of HBV-associated HCC (HBV-HCC). Furthermore, several studies have demonstrated a reduction in recurrent or new HCC development after initial HCC tumor ablation. However, during an observation period spanning 10 to 20 years, several case reports have demonstrated the development of new, subsequent new and recurrent HCC even in patients with undetectable serum HBV DNA. The persistent risk for HCC is attributed to the presence of covalently closed circular DNA (cccDNA) in the hepatocyte nucleus which continues to work as a template for HBV replication. While a functional cure (loss of hepatitis B surface antigen and undetectable viral DNA) can be attained with nucleos(t)ide analogues, these therapies do not eliminate cccDNA. Of utmost importance is successful eradication of the transcriptionally active HBV cccDNA from hepatocyte nuclei which would be considered a complete cure. The unpredictable nature of HCC development in patients with chronic HBV infection shows the need for a complete cure. Continued support and encouragement for research efforts aimed at developing curative therapies is imperative. The aims of this minireview are to highlight these observations and emphasize the need for a cure for HBV.

Recommended Citation

Shinn, Brianna J.; Martin, Aaron; Coben, Robert M.; Conn, Mitchell I.; Prieto, Jorge; Kroop, Howard; DiMarino, Anthony J.; and Hann, Hie-Won, "Persistent risk for new, subsequent new and recurrent hepatocellular carcinoma despite successful anti-hepatitis B virus therapy and tumor ablation: The need for hepatitis B virus cure." (2019). Division of Gastroenterology and Hepatology Faculty Papers. Paper 59.
https://jdc.jefferson.edu/gastro_hepfp/59

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

PubMed ID

30705719

Language

English