High Treatment Adherence Is Associated With Lower Observed HCC Risk in Patients With Chronic Hepatitis B and Cirrhosis: A Nationwide Claims-Based Cohort Study

IF 3.7 3区医学 Q1 VIROLOGY

Journal of Medical Virology Pub Date : 2026-09-28 DOI:10.1002/jmv.71167

Yoon E. Shin, Jae Young Kim, Jeong Ju Yoo, Sang Gyune Kim, Young Seok Kim

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引用次数: 0

Abstract

Adherence to antiviral therapy is essential for viral suppression in chronic hepatitis B (CHB), yet its effect on hepatocellular carcinoma (HCC) remains uncertain. We examined the association between nucleos(t)ide analog (NA) adherence and HCC risk, focusing on tenofovir alafenamide (TAF) versus entecavir (ETV). Treatment-naïve adults with CHB initiating TAF or ETV were identified from the Health Insurance Review and Assessment Service, Republic of Korea. Adherence was measured using the medication possession ratio, with high adherence defined as ≥ 90%, and the primary outcome was HCC incidence. A total of 28 448 patients were included, of whom 19 001 (66.8%) showed high adherence and 9447 (33.2%) showed low adherence. In the overall cohort, HCC incidence was comparable between the high- and low-adherence groups (14.89 vs. 13.76 per 1000 person-years; IRR, 1.08; 95% CI, 0.95–1.24). Among patients with claims-defined cirrhosis, however, high adherence was associated with lower observed HCC incidence (32.92 vs. 49.59 per 1000 person-years; IRR, 0.66; 95% CI, 0.57–0.78), and this association remained significant in multivariable Cox regression (HR, 0.77; 95% CI, 0.66–0.90) as well as in IPTW, landmark, and sensitivity analyses. In exploratory regimen-stratified analyses, high-adherence TAF users showed a lower observed cumulative HCC incidence than high-adherence ETV users, whereas no significant difference was observed in the low-adherence group. Logistic regression identified ETV use as a predictor of low adherence (OR, 2.80; 95% CI, 2.65–2.96). High adherence to antiviral therapy was associated with lower observed HCC incidence among patients with CHB and claims-defined cirrhosis. Although this association remained evident across multiple analyses, residual confounding, treatment-selection effects, time-related bias, and competing-risk issues cannot be fully excluded.

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高治疗依从性与慢性乙型肝炎和肝硬化患者观察到的较低HCC风险相关：一项全国性的基于索赔的队列研究

坚持抗病毒治疗对于抑制慢性乙型肝炎（CHB）的病毒至关重要，但其对肝细胞癌（HCC）的影响仍不确定。我们研究了核苷(t)类似物（NA）依从性与HCC风险之间的关系，重点是替诺福韦（TAF）与恩替卡韦（ETV）。Treatment-naïve启动TAF或ETV的CHB成人从大韩民国健康保险审查和评估服务中心确定。依从性用药物持有率来衡量，高依从性定义为≥90%，主要终点是HCC发生率。共纳入28448例患者，其中高依从性19 001例（66.8%），低依从性9447例（33.2%）。在整个队列中，HCC发病率在高依从组和低依从组之间具有可比性（14.89 vs 13.76 / 1000人年；IRR, 1.08; 95% CI, 0.95-1.24）。然而，在声称定义为肝硬化的患者中，高依从性与较低的观察到的HCC发生率相关（每1000人年32.92 vs 49.59； IRR, 0.66; 95% CI, 0.57-0.78），这种关联在多变量Cox回归（HR, 0.77; 95% CI, 0.66-0.90）以及IPTW、里程碑和敏感性分析中仍然显著。在探索性方案分层分析中，高依从性TAF使用者比高依从性ETV使用者观察到的累积HCC发病率更低，而在低依从性组中没有观察到显著差异。Logistic回归发现使用ETV是低依从性的预测因子（OR, 2.80; 95% CI, 2.65-2.96）。对抗病毒治疗的高依从性与CHB和声称定义的肝硬化患者中观察到的较低HCC发生率相关。虽然这种关联在多个分析中仍然很明显，但残留混淆、治疗选择效应、时间相关偏差和竞争风险问题不能完全排除。

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来源期刊

Journal of Medical Virology 医学-病毒学

CiteScore

23.20

自引率

2.40%

发文量

777

审稿时长

1 months

期刊介绍： The Journal of Medical Virology focuses on publishing original scientific papers on both basic and applied research related to viruses that affect humans. The journal publishes reports covering a wide range of topics, including the characterization, diagnosis, epidemiology, immunology, and pathogenesis of human virus infections. It also includes studies on virus morphology, genetics, replication, and interactions with host cells. The intended readership of the journal includes virologists, microbiologists, immunologists, infectious disease specialists, diagnostic laboratory technologists, epidemiologists, hematologists, and cell biologists. The Journal of Medical Virology is indexed and abstracted in various databases, including Abstracts in Anthropology (Sage), CABI, AgBiotech News & Information, National Agricultural Library, Biological Abstracts, Embase, Global Health, Web of Science, Veterinary Bulletin, and others.