Use of interferon for prevention of hepatocellular carcinoma in cirrhotic patients with hepatitis B or hepatitis B virus infection

The incidence of hepatocellular carcinoma in North America is increasing. C urrent debate focuses on whether interferon administered to cirrhotic patie nts-with or without biochemical or virologic response-delays or prevents ca ncer of the liver. Review of the literature revealed several studies that s howed improvement in or delay in progression of histologic fibrosis in pati ents with hepatitis C virus (HCV) infection. In patients with hepatitis B v irus (HBV) infection, conversion to the nonreplicative stage may be associa ted with histologic improvement. However, only 11 studies (6 of HCV, 3 of H BV, and 2 of HCV and HBV) compared development of hepatocellular carcinoma in interferon-treated patients with cirrhosis and cirrhotic patients who we re not treated with interferon. Although no firm statistical conclusions co uld be drawn, the literature suggests that interferon therapy may prevent h epatocellular carcinoma in patients with cirrhosis, particularly those infe cted with HCV. Interferon treatment cannot be recommended for all persons with cirrhosis a nd HBV or HCV infection because the current evidence is only suggestive. Lo ng-term randomized, controlled trials may provide definitive data; however, it will be difficult, if not impossible, to conduct such trials because of the improved efficacy of combination therapy with interferon and ribavirin in patients with chronic HCV infection and the development of new therapie s for patients with HBV infection.