HCV eradication induced by direct-acting antiviral agents reduces the risk of hepatocellular carcinoma
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BACKGROUND AND AIMS: It is unclear whether direct-acting antiviral (DAA) treatment-induced sustained virologic response (SVR) reduces the risk of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) infection. We aimed to determine the impact of DAA-induced SVR on HCC risk.
METHODS: We identified 62,354 patients who initiated antiviral treatment in the Veterans Affairs (VA) national healthcare system from 1/1/1999 to 12/31/2015, including 35,871 (58%) interferon-only regimens, 4535 (7.2%) DAA+interferon regimens and 21,948 (35%) DAA-only regimens. We retrospectively followed patients until 6/15/2017 to identify incident cases of HCC. We used Cox proportional hazards regression to determine the association between SVR and HCC risk or between type of antiviral regimen (DAA-only vs DAA+interferon vs Interferon-only) and HCC risk.
RESULTS: We identified 3271 incident cases of HCC diagnosed at least 180 days after initiation of antiviral treatment during a mean follow-up of 6.1 years. The incidence of HCC was highest in patients with cirrhosis and treatment failure (3.25 per 100 patient-years), followed by cirrhosis and SVR (1.97), no cirrhosis and treatment failure (0.87) and no cirrhosis and SVR (0.24). SVR was associated with a significantly decreased risk of HCC in multivariable models irrespective of whether the antiviral treatment was DAA-only (adjusted hazard ratio [AHR] 0.29, 95% CI 0.23-0.37), DAA+interferon (AHR 0.48, 95% CI 0.32-0.73) or interferon-only (AHR 0.32, 95% CI 0.28-0.37). Receipt of a DAA-only or DAA+interferon regimen was not associated with increased HCC risk compared to receipt of an interferon-only regimen.
CONCLUSIONS: DAA-induced SVR is associated with a 71% reduction in HCC risk. Treatment with DAAs is not associated with increased HCC risk compared to treatment with interferon.
LAY SUMMARY: Eradication of hepatitis C infection with direct-acting antiviral agents reduces the risk of liver cancer dramatically.
George N Ioannou
George N Ioannou
George N Ioannou,Pamela K Green,Kristin Berry