HCV Eradication Linked to Reduced Risk for Hepatocellular Carcinoma and Death

In patients with chronic hepatitis C virus (HCV) infection, achieving a sustained virologic response as a result of treatment with interferon-based therapy or direct-acting antivirals is associated with a reduced risk for developing hepatocellular carcinoma (HCC) and all-cause mortality, according to study results published in Scientific Reports.¹

Patients with advanced hepatic fibrosis are at increased risk for HCC or hepatic decompensation within a short period of time. However, this risk can be decreased with HCV eradication by immediate initiation of antiviral therapy.^2-7 Therefore, researchers sought to analyze the association between eradication of HCV and the risk for HCC occurrence and death in HCV-infected patients according to hepatic fibrosis grade.¹ The fibrosis grade was categorized using the Fibrosis-4 (FIB-4) index for liver fibrosis, with scores <1.45 having a low probability of significant fibrosis, 1.45 to 3.25 an intermediate probability of significant fibrosis, and ³3.25 a high probability of significant fibrosis.

The researchers found that of 1373 patients with chronic hepatitis C, 418 were treated with interferon-based therapy and 326 with direct-acting antivirals, and 622 of these patients (83.6%) achieved a sustained virologic response. The sustained virologic response group had a significantly lower risk for HCC than patients in the untreated group with intermediate-probability (P =.004) and high-probability (P <.001) of significant fibrosis. Thus, sustained virologic response was independently associated with a lower risk for HCC (P <.001) and overall death (P <.001) compared with untreated patients.

“In summary, reduced risk of developing HCC and all-cause mortality was observed in patients with chronic HCV infection achieving viral eradication with antiviral treatment including IFN-based therapy and direct-acting antivirals, and the beneficial effect of sustained virologic response on the risk of HCC was verified in patients with intermediate- or high-probability of significant fibrosis (FIB-4 ≥1.45)” noted the study authors.¹

References

1. Lee YB, Nam JY, Lee J-H, et al. Differential effect of HCV eradication and fibrosis grade on hepatocellular carcinoma and all-cause mortality. Sci Rep. 2018;8:13651.  

2. van der Meer AJ, Veldt BJ, Feld JJ, et al. Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA. 2012;308:2584-2593.

3. Nahon P, Bourcier V, Layese R, et al. Eradication of hepatitis C virus infection in patients with cirrhosis reduces risk of liver and non-Liver complications. Gastroenterology. 2017;152:142-156.

4. Janjua NZ, Chong M, Kuo M, et al. Long-term effect of sustained virological response on hepatocellular carcinoma in patients with hepatitis C in Canada. J Hepatol. 2017;66:504-513.

5. World Health Organization. Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection. www.who.int/hepatitis/publications/hepatitis-c-guidelines-2016/en/ Accessed October 22, 2018.

6. American Association for the Study of Liver Diseases-Infectious Diseases Society of America (AASLD-IDSA). Recommendations for testing, managing, and treating hepatitis C. www.hcvguidelines.org/full-report-view. Accessed October 22, 2018.

7. European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C 2016. J Hepatol. 2017;66:153-194.