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Invited Commentary
March 18, 2019

Aspirin Use and Risk of Hepatocellular Carcinoma in Hepatitis B

Author Affiliations
  • 1Division of General Internal Medicine, School of Medicine, University of California, San Francisco
  • 2Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven
  • 3Division of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
  • 4Division of Gastroenterology, School of Medicine, University of Pennsylvania Philadelphia
  • 5Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
JAMA Intern Med. 2019;179(5):640-641. doi:10.1001/jamainternmed.2018.8314

Liver cancer (hepatocellular carcinoma [HCC]) incidence and mortality rates have been increasing in most countries for several decades. Currently, HCC is the second most common cause of cancer-related death in the world and represents the fastest rising cause of cancer-related deaths in the United States.1 Chronic hepatitis B virus (HBV) and hepatitis C virus are the primary underlying causes of HCC, with contributions from alcohol, tobacco, aflatoxin, obesity, and metabolic syndrome. In patients with chronic hepatitis C virus, the risk of HCC can be reduced rapidly with short-term, direct-acting antiviral medications. In chronic HBV, oncogenesis starts with viral DNA integration into the genome of host hepatocytes that induces a cascade of host responses, including cell injury, necrosis, and angiogenesis, reflected clinically by the levels of serum alanine aminotransferase and HBV DNA, both of which are predictors of HCC.

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