The incidence of hepatocellular carcinoma (HCC) is reduced in patients with chronic hepatitis C genotype 4 with liver cirrhosis and advanced hepatic fibrosis who achieve sustained virologic response after direct-acting antiviral (DAA) treatment, according to a prospective observational cohort study published in the Journal of Viral Hepatitis.  

Liver cirrhosis is an important risk factor for HCC, which occurs in approximately 3% to 8% chronic hepatitis C cirrhotic patients each year. While the availability of DAAs with excellent safety profiles and higher efficacy has enabled treatment of chronic hepatitis C patients with advanced fibrosis and cirrhosis, the effect of evidencing sustained virologic response in patients treated with DAAs on the incidence of HCC remains to be confirmed.

Therefore, researchers conducted a prospective observational study to determine the incidence of HCC in chronic hepatitis C genotype 4 patients with liver cirrhosis and advanced liver fibrosis after demonstrating sustained virologic response for 12 months after DAA therapy. Liver fibrosis was assessed using transient elastography.

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Of 2372 chronic HCV patients (638 patients with F3 and 1734 with F4 stage) with sustained virologic response for 12 months, 109 patients developed HCC for the first time over the follow-up period (mean 23.60±8.25 months). The overall HCC incidence was found to be 2.338/100 patient-years, with an incidence of 2.917/100 patient-years in patients with cirrhosis and 0.664/100 patient-years in patients with advanced liver fibrosis.

Results also demonstrated that patients with HCC were older, were predominantly male, and had higher baseline levels of alpha-fetoprotein, total bilirubin, and aspartate transaminase and lower levels of serum albumin and platelets.

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Among other limitations, researchers highlighted that there was the lack of a control group of untreated patients and an absence of patients who did not achieve sustained virologic response.

“Our study showed that the annual incidence of HCC is 2.9/100 [patient-years] in cirrhotic patients who achieved [sustained virologic response] following direct acting antiviral treatment for hepatitis C genotype 4,” stated the study authors.


Shiha G, Mousa N, Soliman R, Mikhail NNNH, Elbasiony MA, Khattab M. Incidence of HCC in chronic hepatitis C patients with advanced hepatic fibrosis who achieved SVR following DAAs: A prospective study [published online February 12, 2020]. J Viral Hepat. doi:10.1111/jvh.13276