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With the advent of direct-acting antivirals (DAAs), successful eradication of chronic hepatitis C virus (HCV) infection is high even among patients with advanced liver disease. However, the risk for hepatocellular carcinoma (HCC) after sustained virologic response (SVR) is unknown, and recent studies have given conflicting results.
To determine the risk for HCC in patients treated with DAAs, investigators conducted a large retrospective cohort study involving 22,500 HCV patients (39% with cirrhosis) who received DAAs at 129 Veterans Health Administration hospitals in 2015. The researchers used the Central Cancer Registry to identify patients who developed HCC. The main outcome was new cases of HCC after completion of DAA therapy.
Ultimately, 19,518 patients (87%) achieved SVR. A total of 271 new cases of HCC were identified during the study period. HCC incidence was significantly lower among patients who achieved SVR versus those who did not (0.90 vs. 3.45 per 100 person-years; P<0.0001). The presence of cirrhosis was associated with highest risk for developing HCC; older age and alcohol use also increased HCC risk.
Kanwal F et al. Risk of hepatocellular cancer in HCV patients treated with direct acting antiviral agents. Gastroenterology 2017 Jun 19; [e-pub]. (http://dx.doi.org/10.1053/j.gastro.2017.06.012)
Comment
These results show that SVR in HCV patients treated with DAAs affords a 76% reduction in risk for developing HCC, compared with those who did not achieve SVR. The key driver of HCC in patients with SVR was cirrhosis, which highlights the need to treat HCV patients before they become cirrhotic.