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Nevertheless, <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> is more often seen in older patients in whom <jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> has been asserting its pro\u2010oncogenic properties through both indirect and direct mechanisms. In Europe, <jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>\u2010related <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> is associated with cirrhosis in most patients, whereas this is not true in Asia and Africa where the tumour is also common among carriers with mild hepatic fibrosis, probably because of the coexistence of environmental co\u2010carcinogens (aflatoxin) and long standing infection that is often acquired perinatally. Since hepatitis B\u2010related carcinogenesis develops independently of the onset of cirrhosis, antiviral treatments such as nucleo(t)side analogues (<jats:styled-content style=\"fixed-case\">NA<\/jats:styled-content>s) that may result in the regression of fibrosis, prevent clinical decompensation and variceal bleeding, often fail to prevent <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content>.<\/jats:p><jats:p>Studies enrolling patients treated with lamivudine or rescued with adefovir, i.e. regimens characterized by limited potency and a low to moderate genetic barrier, have clearly been shown to help prevent <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> in patients with chronic hepatitis but not in those with cirrhosis, and in general not in patients that cannot achieve a sustained virological response.<\/jats:p><jats:p>More potent anti\u2010<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> drugs, such as entecavir and tenofovir, have been shown to improve the prevention of <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> in responders with cirrhosis, although <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> may still occur even in low risk patients. To attenuate <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> related outcomes, <jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> replication must permanently be suppressed and <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> surveillance by abdominal ultrasound should be maintained even in responder patients.<\/jats:p>","DOI":"10.1111\/liv.12394","type":"journal-article","created":{"date-parts":[[2013,12,23]],"date-time":"2013-12-23T07:49:39Z","timestamp":1387784979000},"page":"139-145","source":"Crossref","is-referenced-by-count":28,"title":["Impact of <scp>HBV<\/scp> therapy on the incidence of hepatocellular carcinoma"],"prefix":"10.1111","volume":"34","author":[{"given":"Michela","family":"Triolo","sequence":"first","affiliation":[{"name":"1st Division of Gastroenterology Department of Liver Kidney Lung and Bone Marrow Units and Organ Transplant A.M. &amp; A. 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