In the Journals

Veterans with HCV genotype 3 at greater risk for cirrhosis, HCC

Veterans with hepatitis C virus infection genotype 3 displayed an increased risk for cirrhosis and hepatocellular carcinoma compared with other genotypes, according to new study data.

Fasiha Kanwal, MD, MSHS, of the department of medicine at Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, and colleagues studied 110,484 patients from the VA HCV Clinical Case Registry between 2000 and 2009. Patients (mean age, 51.9 years; 97% men; 52.6% white) were followed for a mean of 5.4 years, and 70.2% were Vietnam-era veterans. Of the patients, 79.9% had hepatitis C virus (HCV) genotype 1, 11.8% had genotype 2, 7.5% had genotype 3, and 0.9% had genotype 4.

Fasiha Kanwal

HCV genotype 3 patients had the greatest incident rate ratio of cirrhosis per 1,000 person-years at 30 (95% CI, 28.2-31.8) compared with genotype 1 (IRR=21.5, 95% CI, 21.1-21.9), genotype 2 (IRR=16.6, 95% CI, 15.6-17.7) and genotype 4 (IRR=20.4, 95% CI, 16.8-24.7). Hepatocellular carcinoma (HCC) incident rates per 1,000 person-years also were greatest in the genotype 3 group (7.9) vs. those with genotypes 1, 2 and 4 (4.8, 2.9 and 4.7, respectively).

In univariate analysis HCV genotype 3 was associated with a 40% increased risk for incident cirrhosis (HR=1.4; 95% CI, 1.32-1.5) and a 66% increased risk for HCC (HR=1.66; 95% CI, 1.48-1.85) compared with genotype 1 patients. Those with HCV genotype 3 were 53% and 59% more likely to have prevalent cirrhosis and HCC compared with genotype 1 patients.

“We found that HCV genotype 3 was associated with a significantly increased risk of developing cirrhosis and HCC compared to the more common HCV genotype 1,” Kanwal told Healio.com/Hepatology. “Newer and more efficacious regimens for HCV genotype 3 patients may eventually become available. However, our data show that a substantial proportion of patients with genotype 3 infection already have developed cirrhosis; these patients will likely remain at risk for HCC. Thus, HCV genotype 3 infection may have a major role to screen for patients who are at an increased risk for HCC.”

Disclosure: Jennifer R. Kramer, PhD, MPH, reports receiving salary support from Gilead Sciences.

Veterans with hepatitis C virus infection genotype 3 displayed an increased risk for cirrhosis and hepatocellular carcinoma compared with other genotypes, according to new study data.

Fasiha Kanwal, MD, MSHS, of the department of medicine at Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, and colleagues studied 110,484 patients from the VA HCV Clinical Case Registry between 2000 and 2009. Patients (mean age, 51.9 years; 97% men; 52.6% white) were followed for a mean of 5.4 years, and 70.2% were Vietnam-era veterans. Of the patients, 79.9% had hepatitis C virus (HCV) genotype 1, 11.8% had genotype 2, 7.5% had genotype 3, and 0.9% had genotype 4.

Fasiha Kanwal

HCV genotype 3 patients had the greatest incident rate ratio of cirrhosis per 1,000 person-years at 30 (95% CI, 28.2-31.8) compared with genotype 1 (IRR=21.5, 95% CI, 21.1-21.9), genotype 2 (IRR=16.6, 95% CI, 15.6-17.7) and genotype 4 (IRR=20.4, 95% CI, 16.8-24.7). Hepatocellular carcinoma (HCC) incident rates per 1,000 person-years also were greatest in the genotype 3 group (7.9) vs. those with genotypes 1, 2 and 4 (4.8, 2.9 and 4.7, respectively).

In univariate analysis HCV genotype 3 was associated with a 40% increased risk for incident cirrhosis (HR=1.4; 95% CI, 1.32-1.5) and a 66% increased risk for HCC (HR=1.66; 95% CI, 1.48-1.85) compared with genotype 1 patients. Those with HCV genotype 3 were 53% and 59% more likely to have prevalent cirrhosis and HCC compared with genotype 1 patients.

“We found that HCV genotype 3 was associated with a significantly increased risk of developing cirrhosis and HCC compared to the more common HCV genotype 1,” Kanwal told Healio.com/Hepatology. “Newer and more efficacious regimens for HCV genotype 3 patients may eventually become available. However, our data show that a substantial proportion of patients with genotype 3 infection already have developed cirrhosis; these patients will likely remain at risk for HCC. Thus, HCV genotype 3 infection may have a major role to screen for patients who are at an increased risk for HCC.”

Disclosure: Jennifer R. Kramer, PhD, MPH, reports receiving salary support from Gilead Sciences.