Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory for Liver Research, University of Hong Kong, Queen Mary Hospital, Hong Kong. email@example.com.
Chronic hepatitis B infection is the major cause of hepatocellular carcinoma. Primary prevention of hepatitis B infection by vaccination is effective in reducing the incidence of hepatocellular carcinoma. In persons with chronic hepatitis B infection, the two accepted treatment modalities are interferon-alpha given subcutaneously for a limited period and nucleos(t)ide analogues given orally on a long-term basis. These treatments are effective in suppressing the viral activity and improving disease markers in short-term studies. The long-term effect on the development of liver cancers with these two forms of treatment appears to be different. However there are no studies directly comparing interferon-alpha and nucleos(t)ide analogues. Comparisons across studies are inevitably limited by differences in the baseline characteristics of the study cohorts. Long-term follow-up studies of interferon-alpha therapy show inconsistent results. The beneficial effect in reducing the development of liver cancer is observed mainly in treatment responders who have pre-existing cirrhosis of the liver. The long-term studies of lamivudine (and adefovir) show a consistent reduction in the development of liver cancers in patients with, and without, cirrhosis. This beneficial effect is blunted by the development of resistance. The effects of the newer nucleos(t)ide analogues, with higher potency and minimal risk of resistance development, are as yet unknown.