A Risk for Hepatocellular Carcinoma Persists Long-term After Sustained Virologic Response in Patients With Hepatitis C–Associated Liver Cirrhosis

Aleman, Soo; Rahbin, Nogol; Weiland, Ola; Davíðsdóttir, Lóa; Hedenstierna, Magnus; Rose, Nina; Verbaan, Hans; Stål, Per; Carlsson, Thomas; Norrgren, Hans; Ekbom, Anders; Granath, Fredrik; Hultcrantz, Rolf

doi:10.1093/cid/cit234

Cited by 217 publications

(236 citation statements)

References 22 publications

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“…However, the proportion with continued excessive alcohol consumption after HCV diagnosis is unknown. In a previous study, the risk for decompensation and liver-related death after achieving SVR was low in cirrhotic patients in Sweden [51], potentially indicating limited impact of this comorbidity.…”

Section: Discussionmentioning

confidence: 85%

“…Another limitation is that the model does not consider the decreased but remaining risk of HCC and disease progression among cirrhotic patients that achieved SVR [51]. This may result in an underestimation of future burden of disease and overstate the potential impact of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…This may result in an underestimation of future burden of disease and overstate the potential impact of treatment. To estimate HCC and decompensation in cirrhotic patients with SVR, incidence rates of 1.02% (HCC) and 0.85% (decompensated cirrhosis) [51] were applied to these cases, after accounting for background mortality. Under the baseline scenario, from 2014 to 2030, there were between 2 and 4 HCC cases annually (average = 3 cases), increasing to between 2 and 8 cases annually under the most effective DAA scenario (average = 7 cases).…”

Section: Discussionmentioning

confidence: 99%

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The future disease burden of hepatitis C virus infection in Sweden and the impact of different treatment strategies

Duberg

Blach

Falconer

et al. 2014

Scandinavian Journal of Gastroenterology

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Objective. Recently, new highly effective direct-acting antivirals (DAAs) against hepatitis C virus (HCV) were introduced. Whether these will alleviate the anticipated increase of liver disease burden in Sweden is unknown, partly because high costs may restrict the use. The objectives were to model the HCV epidemic in Sweden, the burden of disease, and the potential impact of different treatment strategies. Material and methods. HCV disease progression was modeled to 2030. Scenarios were simulated using new DAAs with sustained annual treatment rate (n = 1130), reduced treatment rate (n = 380) to maintain budget, and increased treatment rates (n = 1430 or 2260) to reduce HCV infections. Results. With today's triple therapies, the estimated number of serious liver complications and death are expected to peak in 2021. Using new DAAs among F0-F4 patients, an unchanged annual treatment rate can reduce the number of HCV infections by 10% by 2030; however, hepatocellular carcinoma (HCC) and mortality will remain unchanged. By reducing to 380 treatments annually and focusing on patients with advanced fibrosis (F3-F4), serious complications will remain constant but the total number of HCV infections will increase. By doubling the number of DAA treatments, HCC-incidence and liver-related deaths would decrease by 65-70% by 2030. Conclusion. Mortality and HCC can be reduced with new DAAs and sustained treatment uptake when restricted to F2-F4 patients, or with increased uptake in F0-F4 patients. Treatment restrictions to limit cost may reduce the positive effects and increase the burden of HCV infection. These results may be important for the future strategies of HCV management.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The future disease burden of hepatitis C virus infection in Sweden and the impact of different treatment strategies

Duberg

Blach

Falconer

et al. 2014

Scandinavian Journal of Gastroenterology

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“…Overall, the incidences of CKD, DM, CVD, and death were 5.32 (95 % CI 3.99-6.98), 10.13 (95 % CI 8.20-12.37), 6.79 (95 % CI 5.26-8.65), and 13.49 (95 % CI 11.29-16.0) per 1000 PYFU, respectively. Kaplan-Meier curves showing the occurrence of extrahepatic events and deaths according to the study groups are reported in Fig.…”

Section: Discussionmentioning

confidence: 99%

“…HIV/hepatitis C virus (HCV)-coinfected patients have accelerated progression of HCV-related liver disease and increased mortality rate compared to HCV-or HIV-monoinfected patients. There is increasing evidence that the achievement of sustained virologic response (SVR) after pegylated interferon (peg-IFN) plus ribavirin (RBV) treatment reduces the incidence of hepatocellular carcinoma (HCC), liver decompensation, and overall mortality in HIV/HCV-coinfected patients [3][4][5][6]. Although HCV coinfection is associated with an increased risk of cardiovascular disease (CVD), chronic kidney disease (CKD), and diabetes mellitus (DM) among HIV-infected patients, the impact of SVR on the risk of the development of extrahepatic complications has been little investigated [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of cardiovascular disease, chronic kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved sustained virological response

Leone

Prosperi

Costarelli

et al. 2016

Eur J Clin Microbiol Infect Dis

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Data on the effects of sustained virologic response (SVR) to hepatitis C virus (HCV) therapy on the outcome of extrahepatic complications are scarce. We conducted this study to assess the impact of SVR on the occurrence of chronic kidney disease (CKD), diabetes mellitus (DM), and cardiovascular disease (CVD) in a cohort of human immunodeficiency virus (HIV)-infected patients. We analyzed coinfected HIV/HCV patients in the Management of Standardized Evaluation of Retroviral HIV Infection (MASTER) cohort. Only event-free patients with a serum HCV-RNA determination at baseline were included. Patients were divided into four groups: INFexposed with SVR; INF-exposed without SVR; spontaneous HCV clearance; untreated viremic patients. We estimated the incidence of extrahepatic complications and employed Kaplan-Meier curves and Cox regression to assess the association of SVR/INF strata adjusted for a series of confounders. Data from 1676 patients were analyzed (20.29 % started an INF-based regimen). Overall, the incidence of CKD, DM, CVD, and death was 5.32 [95 % confidence interval (CI) 3.99-6.98], 10.13 (95 % CI 8.20-12.37), 6.79 (95 % CI 5.26-8.65), and 13.49 (95 % CI 11.29-16.0) per 1000 person-years of follow-up, respectively. In the Cox model for treated patients, SVR was not associated with a lower risk of CKD, DM, CVD, and death compared to non-SVR. Cirrhosis was significantly associated with a higher risk of CKD [hazard ratio (HR) 2.13; 95 % CI 1.06-4.31], DM (HR 3.48;, and death (HR 6.18;), but not of CVD (HR 1.14; 95 % CI 0.57-2.3). There are still many unknowns regarding the impact of SVR on the occurrence of extrahepatic complications in coinfected HIV/ HCV patients. Further investigations are needed in order to elucidate the role of SVR as an independent prognostic factor for extrahepatic events.

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HepatitisCVirus (HCV) Infection: in Special Situations

Koukoulioti

Berg

2019

Evidence‐based Gastroenterology and Hepatology 4e

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A Risk for Hepatocellular Carcinoma Persists Long-term After Sustained Virologic Response in Patients With Hepatitis C–Associated Liver Cirrhosis

Cited by 217 publications

References 22 publications

The future disease burden of hepatitis C virus infection in Sweden and the impact of different treatment strategies

The future disease burden of hepatitis C virus infection in Sweden and the impact of different treatment strategies

Incidence and predictors of cardiovascular disease, chronic kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved sustained virological response

HepatitisCVirus (HCV) Infection: in Special Situations

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