Direct-Acting Antivirals Reduce Hepatocellular Carcinoma Risk in Hepatitis C

map with hepatitis C virus
map with hepatitis C virus
Data has yet to be published for patients with hepatitis C in Latin America, but in a prospective study, researchers found that after treatment with antivirals, those with advanced liver disease still had a propensity for hepatocellular carcinoma.

For patients with chronic hepatitis C virus (HCV) infection, treatment with direct antiviral agents (DAAs) reduces, but does not eliminate, the risk of developing hepatocellular carcinoma (HCC), according to results published in Liver International.

The study included participants from Latin America with chronic HCV infection and any degree of liver fibrosis who were treated with DAAs (n=1400). The researchers used Cox proportional regression models to evaluate independent associated variables with HCC.

The median follow-up after DAA initiation was 16 months (interquartile range, 8.9-23.4 months). 

During this time, the overall cumulative incidence of HCC was 0.02 at 12 months and 0.04 at 24 months. Among participants with cirrhosis (n=784), the cumulative incidence of HCC was 0.03 at 12 months and 0.06 at 24 months. The researchers found that participants with F4 liver fibrosis and clinically significant portal hypertension had the highest risk for HCC, with a hazard ratio (HR) of 13.3.

The results indicated that failing to achieve sustained virological response (SVR) was independently associated with de novo HCC (HR 4.9, 95% CI, 1.44-17.32). Participants who achieved SVR had a 73% overall relative risk reduction for de novo HCC.

“Early treatment to prevent cirrhosis is the preferred strategy to avoid liver cancer development,” the researchers wrote. “Consequently, in our region we should implement strong public health strategies to provide treatment of HCV infection in early stages of liver disease if our goal is to further diminish de novo incidence of HCC.”

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Piñero F, Mendizabal M, Riduejo E, et al. Treatment with direct-acting antivirals for HCV decreases but does not eliminate the risk for hepatocellular carcinoma [published online January 13, 2019]. Liver Int. doi: 10.1111/liv.14041