Between 2000 and 2014, the individual risk for HBV-related hepatocellular carcinoma in New South Wales, Australia declined, according to recent findings published in the Journal of Hepatology. However, population level HBV-related HCC stayed the same.
“During the same period, HCV–HCC population-level burden has risen markedly, and individual-level HCV–HCC risk has been stable,” Reem Waziry, MD, MPH, PhD candidate at the Viral Hepatitis Clinical Research Program at the Kirby Institute for Infection and Immunity in Society at the University of New South Wales, and colleagues wrote. “Although linkage to individual-level HBV and HCV treatment data was not possible, the contrasting trends suggest a favorable impact of improving HBV antiviral therapy since the mid-2000s and no significant impact of interferon-based HCV therapy.”
Mandatory notification of HBV and HCV diagnoses in Australia provided the opportunity to assess trends in HCC among individuals with HBV and HCV, the researchers wrote.
Waziry and colleagues used data on HBV and HCV notifications between 2000 and 2014 from the New South Wales Admitted Patients Data Collection database and the New South Wales Registry of Births Deaths and Marriages. Then they calculated the HCC burden and age-standardized incidence based on first hospitalization.
Between 2000 and 2014, there were 54,399 individuals with HBV, 93,099 with HCV and 3,809 with HBV and HCV coinfection.
Among those with HBV, 1.3% also had HCC. However, HCC incidence decreased from 53 in 2001 to 44 in 2013. The age-standardized HCC incidence rates declined from 2.3 per 1,000 person-years (95% CI, 1.4-3.1) in 2001 to 0.9 (95% CI, 0.5-1.2) in 2012. Factors associated with HCC included a later study period beginning in 2005 (HR = 0.54; 95% CI, 0.42-0.7), male sex (HR = 4.5; 95% CI, 3.6-5.6), Asia-Pacific country of birth (HR = 3.84; 95% CI, 2.58-5.71) and alcohol dependency (HR = 2.84; 95% CI, 1.95-4.13).
Comparatively, 1.4% of those with HCV had HCC. Further, HCC increased in this cohort from 49 in 2001 to 151 in 2013. The age-standardized HCC incidence rates changed little from 1.4 (95% CI, 0.8-1.9) in 2001 to 1.5 in 2012 (95% CI, 1.2-1.7). Factors associated with HCC included male sex (HR = 2.56; 95% CI, 2.2-2.98), rural place of residence (HR = 0.73; 95% CI, 0.62-0.86), Asia-Pacific country of birth (HR = 2.37; 95% CI, 1.99-2.82) and alcohol dependency (HR = 3.9; 95% CI, 3.39-4.49).
These results suggest that the more effective HBV antiviral therapy arriving in the mid-2000s had a large impact, the researchers wrote. However, the results also suggest that the interferon-containing HCV treatment era had little impact.
“The recent development of highly effective interferon-free DAA therapy, and Australian Government subsidization of several regimens from March 2016 provides the opportunity to rapidly scale-up HCV antiviral therapy and provide individual-level and population-level benefits in terms of HCC and other liver disease burden reductions,” the researchers wrote. “The relatively high HCV diagnosis rate in Australia, and the particularly enhanced efficacy and tolerability of these regimens in the setting of advanced liver disease provides considerable optimism for a major impact on HCV–HCC burden.” – by Will Offit
Disclosure: Waziry reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.