Expected Increase of Hepatocellular Carcinoma in Patients Cured from HCV

New cases of hepatocellular carcinoma (HCC) among patients virologically cured from hepatitis C virus (HCV) will continue to increase through 2040, according to a study published in JAMA Network Open. Additionally, the burden of HCC risk surveillance is expected to move from patients with active HCV to patients who already achieved virological cure. Emphasizing routine screening for early detection of HCC in virologically cured HCV patients can address this shift.

The advent of direct-acting antivirals (DAAs) in 2011 has made a marked impact on HCV treatment. However, patients are still at risk of developing HCC even after virological cure. Investigators projected the number of adult HCV patients in the United States who developed HCC and were candidates for routine HCC surveillance between 2012 and 2040 to help guide primary and specialty care providers optimally manage HCV patients.

Investigators conducted a decision analytical model study using the Hepatitis C Disease Burden Simulation model (HEP-SIM). The population included those in the National Health and Nutrition Examination Survey (NHANES) as well as incarcerated, homeless, active-duty military service, and nursing home patients.

According to the HEP-SIM model, annual HCC incidence among HCV patients with and without viremia was 18,000 cases (95% uncertainty intervals [UI], 11,000-32,000) in 2012, projected to increase to 24,000 cases (95% UI, 18,000-31,000) in 2021, then decrease to 13,000 cases (95% UI, 11,000-16,000) by 2040. However, the proportion of HCC incidence in virologically cured patients was projected to increase from 5.3% in 2012 to 45.8% by 2040.

The HEP-SIM model also projected that in 2012, 1.24 million patients (95% UI, 0.96 million-1.71 million) with HCV with or without viremia were at risk for developing HCC and would be candidates for HCC surveillance. This number was estimated to increase to 1.49 million patients (95% UI, 1.23 million-1.85 million) in 2020, then gradually decrease to 0.83 million patients (95% UI, 0.66 million-1.04 million) by 2040. However, the proportion of HCC surveillance candidates with virological cure was projected to increase from 8.5% in 2012 to 64.6% in 2040.

Limitations of the study included using aggregate-level parameters to characterize the overall HCC burden, limiting analysis to HCV-associated HCC, and not accounting for fibrosis regression following successful DAA treatment.

“As the number of patients with virologically cured HCV increase[s], the new cases of HCC from this cohort will increase. In addition, the burden of surveillance for HCC will shift from patients with viremia to patients with virologically cured HCV,” the investigators concluded. “Therefore, it is vital to emphasize that biannual HCC surveillance is warranted for these patients in primary care settings.”

Disclosure: several study authors declared receiving personal fees from the pharmaceutical industry. Please see the original reference for a full list of the authors’ disclosures.

Reference

Chen Q, Ayer T, Adee MG, Wang X, Kanwal F, Chhatwal J. Assessment of incidence of and surveillance burden for hepatocellular carcinoma patient with hepatitis C in the era of direct-acting antiviral agents. JAMA Netw Open. 2020;3(11):e2021173. doi:10.1001/jamanetworkopen.2020.21173