{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T18:11:02Z","timestamp":1783620662202,"version":"3.55.0"},"reference-count":34,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["The Ministry of Education, Science and Technology 2018R1A2B2006183"],"award-info":[{"award-number":["The Ministry of Education, Science and Technology 2018R1A2B2006183"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Potent antiviral agents effectively reduce liver-related events in patients with chronic hepatitis B. This study aimed to determine whether alanine aminotransferase normalization using potent antiviral agents was related to hepatocellular carcinoma development. From 2007 to 2017, we included 610 patients with chronic hepatitis B who received entecavir or tenofovir disoproxil fumarate. The patients were divided into the alanine aminotransferase normalization group (Gr.1) and non-normalization group (Gr.2) within a year of potent antiviral treatment. Liver-related events included hepatic encephalopathy, variceal bleeding, and ascites. The mortality rate and hepatocellular carcinoma incidence were investigated for each group. The patients who showed ALT normalization at 1 year of treatment were 397 (65.1%) of 610. During a median follow-up period of 86 months, 65 (10.7%) patients developed hepatocellular carcinoma. The cumulative incidence of hepatocellular carcinoma was significantly lower in Gr.1 than in Gr.2 (p &lt; 0.001). Risk factors for alanine aminotransferase non-normalization were body mass index, cholesterol, and liver cirrhosis at baseline. Male sex, age, platelet level, alcohol use, presence of cirrhosis at baseline, and non-normalization after 1 year of treatment were independent risk factors for hepatocellular carcinoma. Alanine aminotransferase normalization within 1 year of initiating antiviral agents reduces the risk of hepatocellular carcinoma development.<\/jats:p>","DOI":"10.3390\/jcm10091840","type":"journal-article","created":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T12:08:30Z","timestamp":1619179710000},"page":"1840","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Early Normalization of Alanine Aminotransferase during Antiviral Therapy Reduces Risk of Hepatocellular Carcinoma in HBV Patients"],"prefix":"10.3390","volume":"10","author":[{"given":"Sehwa","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"},{"name":"Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam-si 13590, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoonseok","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo Min","family":"Bang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haein","family":"Bak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7346-5974","authenticated-orcid":false,"given":"Sun Young","family":"Yim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6396-0859","authenticated-orcid":false,"given":"Young Sun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang Jae","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam-si 13590, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6566-1382","authenticated-orcid":false,"given":"Young Kul","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeon Seok","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung Joon","family":"Yim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soon Ho","family":"Um","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwan Soo","family":"Byun","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0510-7371","authenticated-orcid":false,"given":"Jong Eun","family":"Yeon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Korea University College of Medicine, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1016\/j.vaccine.2011.12.116","article-title":"Global epidemiology of hepatitis B virus infection: New estimates of age-specific HBsAg seroprevalence and endemicity","volume":"30","author":"Ott","year":"2012","journal-title":"Vaccine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2557","DOI":"10.1053\/j.gastro.2007.04.061","article-title":"Hepatocellular carcinoma: Epidemiology and molecular 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