Researchers found through long-term follow-up that patients with hepatitis C virus infection who achieved sustained virologic response after interferon-based therapy were still at risk for hepatocellular carcinoma, more specifically older patients and those with cirrhosis.
“We present data from a large general population cohort in Canada with long-term follow-up to evaluate the effect of SVR on risk of HCC and estimate the incidence of HCC post-SVR for interferon-based treatments. … [We found] SVR after interferon-based treatment substantially reduces but does not eliminate HCC risk. … Treatment of patients at an advanced fibrosis stage with new highly effective drugs will warrant continued surveillance for HCC post-SVR,” Naveed Z. Janjua, MBBS, MSc, DrPH, clinical associate professor, School of Population and Public Health, University of British Columbia, and colleagues wrote.
Janjua and colleagues evaluated patients from The BC Hepatitis Testers Cohort who tested positive for HCV between 1990 and 2013. Patients who received an interferon-based HCV treatment were followed from the end of treatment to HCC diagnosis, death or December 2012.
Of 8,147 patients who received treatment, 57% achieved SVR (n = 4,663) and 43% did not (n = 3,484). Over a median of 5.6 years for both groups, HCC incidence rate was 1.1 per 1,000 person-years among patients who reached SVR and 7.2 per 1,000 person-years among patients who did not reach SVR. In both groups, patients with cirrhosis had a higher HCC incidence rate compared with patients without cirrhosis (SVR group: 6.4 per 1,000 person-years; non-SVR group: 21 per 1,000 person-years).
In multivariate analysis, SVR was associated with a lower HCC risk (subdistribution HR = 0.2; 95% CI, 0.13-0.3). Cirrhosis (sHR = 2.61; 95% CI, 1.68-4.04), age older than 50 years, male sex and genotype 3 infection were associated with higher risk for HCC.
Among patients who reached SVR, cirrhosis, age older than 50 years and male sex were associated with an increased risk for HCC.
The researchers concluded: “Risk of HCC following SVR is substantially higher among those with cirrhosis and older age at treatment initiation, groups which have been considered for post-SVR surveillance in AASLD and EASL guidelines. As more people are being treated with highly effective direct-acting antivirals at advanced fibrosis stages, continued surveillance for HCC among these patients post-SVR is warranted.” – by Melinda Stevens
Disclosure: Janjua reports no relevant financial disclosures. Please see the study for a list of all other researchers’ relevant financial disclosures.