Background@#Since September 2015, the initiation of
antiviral therapy (AVT) for
patients with
chronic hepatitis B (CHB)-related
cirrhosis has been reimbursed according to the revised Korean
Association for the Study of
Liver (KASL)
guideline, if the
patient had
hepatitis B virus DNA level ≥ 2,000 IU/L, regardless of
aminotransferase or
alanine aminotransferase levels. This study investigated whether the KASL
guideline implementation reduced the
risk of CHB-related
hepatocellular carcinoma (HCC) in
patients with
cirrhosis in
South Korea. @*
Methods@#A total of 429
patients with CHB-related
cirrhosis who initiated AVT between 2014 and 2016 were recruited. The
risk of HCC development was compared between
patients who initiated AVT before and after September 2015 (pre-
guideline [n = 196, 45.7%] vs. postguideline implementation [n = 233, 54.3%]). @*Results@#Univariate
analysis showed that AVT initiation before
guideline implementation, older age,
male gender, and diabetes significantly predicted increased
risk of HCC development (all P < 0.05). Subsequent
multivariate analysis showed that AVT initiation before
guideline implementation (HR = 1.941), older age (HR = 5.762),
male gender (HR = 2.555), and diabetes (HR = 1.568) independently predicted increased
risk of HCC development (all P < 0.05). Additionally,
multivariate analysis showed that AVT initiation before
guideline implementation (HR = 2.309),
male gender (HR = 3.058), and lower
platelet count (HR = 0.989) independently predicted
mortality (P < 0.05). The
cumulative incidences of HCC and
mortality were significantly higher in
patients who initiated AVT before
guideline implementation than in those
who initiated AVT after
guideline implementation (all P < 0.05, log-rank test). @*Conclusion@#The
prognosis of
patients with CHB-related
cirrhosis who initiated AVT improved after
guideline implementation according to the revised KASL
guideline.