SEATTLE — The risk of developing liver cancer continues to be high in patients co-infected with HIV/hepatitis C virus (HCV). However, a new study presented at CROI 2017 is suggesting that the incidence of hepatocellular carcinoma after sustained virological response (SVR) has not increased with the widespread use of all oral direct antivirals regimens as suggested in previous studies.
“There was no evidence for aggressive presentation and I think we have improved our ability to screen and detect cancers,” said study investigator Nicolás Merchante, MD, who is with the University of Valme in Seville, Spain.
The current study findings may be partially explained by the fact that the arrival of all-oral direct antiviral agents have allowed patients to be treated at advanced stages of liver disease in which the protective effect of SVR on the risk may be less marked. Dr Merchante said SVR is associated with a reduction in the risk of liver-related events, including hepatocellular carcinoma (HCC). SVR is also associated with a lower risk of liver-related mortality in patients co-infected with HIV/HCV.
He said it is known that patients with this co-infection who achieve SVR are still at risk for developing HCC. However, it is unknown whether the risk of developing HCC after SVR has been modified with the arrival of all-oral direct antiviral agents, which are interferon-free regimens. Dr Merchante and his colleagues examined the percentage of cases of HCC diagnosed after SVR in patients co-infected with HIV/HCV and how outcomes have changed over time.
The researchers used data from the GEHEP-002 cohort (ClinicalTrials.gov identifier: NCT02785835), which included 319 patients from 32 centers across Spain. The percentage of cases of HCC after SVR and the evolution of this percentage over time were analyzed. The researchers defined 4 specific periods of time according to the changes in treatment strategies for hepatitis C in Spain. The first period was 2001 or earlier (non-pegylated interferon [IFN]); the second period was 2002 to 2011 (pegylated IFN plus ribavirin); the third period was 2011 through October 2014 (all-oral direct antiviral agents in combination with IFN), and the fourth period was October 2014 through September 2016 (all-oral direct antiviral agents that were IFN-free regimens).
The participants’ median age was 49 and 90% were male. HCV genotype distribution was: Gt 1 (49%), Gt 2 (1%), Gt 3 (36%), and Gt 4 (14%).
“The main take-home message is that our study confirms that the incidence of hepatocellular carcinoma after sustained virological response has not increased with the widespread use of all oral direct antivirals regimens as [it] had been suggested in two previous reports. Besides, this study also shows that currently one out of three new diagnosis of liver cancer in HIV/HCV co-infected patients is being performed in a patient that has been previously cured of hepatitis C,” Dr Merchante told Infectious Disease Advisor.
Dr Merchante said the period of time during which patients have been on all-oral direct antiviral interferon-free regimens is a study limitation that must weighed by clinicians. He said patients who developed liver cancer and were on the all-oral direct antiviral interferon-free regimens tended to have lower grade tumors.
Merchante N, Revollo B, Rodríguez-Arrondo F, et al. Hepatocellular carcinoma after SVR with IFN-free regimens in HIV/HCV coinfection. Presented at: CROI 2017. Seattle, WA; February 13-16, 2017. Abstract 139.