Long-term endoscopic surveillance in HBV compensated cirrhotic patients treated with Tenofovir or Entecavir for 11 years.
Farina, E
Loglio, A
Tosetti, G
Degasperi, E
Viganò, M
Gentile, C
Monico, S
Perbellini, R
Borghi, M
Facchetti, F
Uceda Renteria, SC
Ceriotti, F
Cerini, F
Primignani, M
Lampertico, P
Monico, S
Perbellini, R
Borghi, M
Facchetti, F
Uceda Renteria, SC
Ceriotti, F
Cerini, F
Primignani, M
Lampertico, P
- Publisher:
- WILEY
- Publication Type:
- Journal Article
- Citation:
- Aliment Pharmacol Ther, 2023, 57, (12), pp. 1407-1416
- Issue Date:
- 2023-06
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| Aliment Pharmacol Ther - 2023 - Farina - Long‐term endoscopic surveillance in HBV compensated cirrhotic patients treated.pdf | Published version | 668.07 kB |
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BACKGROUND: Long-term administration of TDF/ETV in patients with HBV-related compensated cirrhosis reduces HCC and decompensation events but the effect of this regimen on development/regression of oesophageal varices (EV) is currently unknown. AIM: To assess the risk of EV development/progression in this population. METHODS: A total of 186 Caucasian HBV-monoinfected compensated cirrhotics were enrolled in a long-term cohort study from TDF/ETV introduction. Upper GI endoscopies were performed according to Baveno recommendations. Primary endpoint was development/progression of oesophageal/gastric varices over time. RESULTS: At TDF/ETV start, median age was 61 years, 80% males, 60% HBV-DNA undetectable, 63% NUCs previously exposed, 73% normal ALT, 40% platelets <150,000/mmc and 25 (13%) with low-risk varices (LRV). During 11 years of antiviral therapy and 666 endoscopies performed, 9 patients either developed or had a progression of oesophageal or gastric varices with an 11-year cumulative probability of 5.1% (95% CI 3-10%); no patient bled. Out of 161 patients without EV at baseline, the 11-year probably was 4.5% with all varices developing within the first six years of treatment. In 25 patients with LRV at baseline, the 11-year probability of progression or regression was 9.3% and 58%, respectively. Only baseline platelet count (HR 0.96, p = 0.028) was associated with LRV development at multivariate analysis: platelet ≤90,000/mmc (AUROC 0.70) had 98.1% specificity, 42.9% sensitivity, 50% PPV for LRV onset. CONCLUSIONS: In compensated cirrhotic patients under long-term effective TDF/ETV treatment, the 11-year risk of developing/progressing EV is negligible, thus challenging the current endoscopic surveillance recommendations in patients without EV at baseline.
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