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Abstract Details
Hepatitis B Virus (HBV) Genotype: A Significant Risk Factor in Determining which Patients with Chronic HBV Infection should Undergo Surveillance for Hepatocellular Carcinoma: The Hepatitis B Alaska (HEP-B-AK) Study
Hepatology. 2021 Jul 22. doi: 10.1002/hep.32065. Online ahead of print.
Brian J McMahon12, Solu Nolen2, Mary Snowball1, Chriss Homan1, Susan Negus1, Elena Roik1, Philip R Spradling3, Dana Bruden2
Author information
1Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA.
2Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA.
3Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta Georgia, USA.
Abstract
Background and aims: Information is limited regarding hepatitis B virus (HBV) genotype and the outcome of chronic HBV (CHB) infection. We examined HBV genotype on hepatocellular carcinoma (HCC) occurrence in Alaska Native (AN) persons with CHB where five HBV genotypes are found, A2, B6, C2, D and F1.
Approach and results: We calculated HCC incidence per 1000 person-years of follow-up to determine which groups by age, sex, and genotype met current American Association for the Study of Liver Diseases HCC surveillance criteria. We used Poisson regression to compare HCC risk by genotype, age, sex, and Alaska region. Incidence of HCC was calculated using the sex specific AASLD cutoff recommended for the Asian population of 50 years for women and 40 years for men. HCC screening was conducted semiannually using alpha-fetoprotein levels and abdominal ultrasound. Among 1185 AN persons, median follow up was 35.1 years; 667 (63%) were male. The HBV genotype distribution was: 49% D, 18% F, 13% A, 6% C, 3% B, 0.1% H, and 12% undetermined. Sixty-three cases of HCC occurred. HCC incidence for genotype F was 5.73 per 1000 person-years of follow-up, followed by 4.77 for C, 1.28 for A, 0.47 for D and 0.00 for B. The HCC risk was higher for genotypes F (Relative rate [RR] : 12.7, 95% confidence interval [CI]: 6.1-26.4) , C (RR: 10.6, 95% CI: 4.3-26.0) and A (RR: 2.9, 95% CI: 1.0-8.0) compared to genotypes B or D. Among males < 40 years of age and females < 50 years of age, genotype F had the highest incidence (4.79/1000 person-years).
Conclusions: HBV genotype was strongly associated with HCC HBV genotype should be considered in risk factor stratification.