Cancer in People with and without Hepatitis C Virus Infection: Comparison of Risk Before and After Introduction of Direct-Acting Antivirals

Abstract

Background: Chronic hepatitis C virus (HCV) infection is a leading cause of liver cancer. The association of HCV infection with extrahepatic cancers, and the impact of direct-acting antiviral (DAA) treatment on these cancers, is less well known. Methods: We conducted a cohort study in a healthcare delivery system. Using electronic health record data from 2007 to 2017, we determined cancer incidence, overall and by type, in people with HCV infection and by DAA treatment status. All analyses included comparisons with a reference population of people without HCV infection. Covariate-adjusted Poisson models were used to estimate incidence rate ratios. Results: 2,451 people with HCV and 173,548 people without HCV were diagnosed with at least one type of cancer. Compared with people without HCV, those with HCV were at higher risk for liver cancer [adjusted incidence rate ratio (aIRR) = 31.4, 95% confidence interval (CI) = 28.9–34.0], hematologic cancer (aIRR = 1.3, 95% CI = 1.1–1.5), lung cancer (aIRR = 1.3, 95% CI = 1.2–1.5), pancreatic cancer (aIRR = 2.0, 95% CI = 1.6–2.5), oral/oropharynx cancer (aIRR = 1.4, 95% CI = 1.1–1.8), and anal cancer (aIRR = 1.6, 95% CI = 1.1–2.4). Compared with people without HCV, the aIRR for liver cancer was 31.9 (95% CI = 27.9–36.4) among DAA-untreated and 21.2 (95% CI = 16.8–26.6) among DAA-treated, and the aIRR for hematologic cancer was 1.5 (95% CI = 1.1–2.0) among DAA-untreated and 0.6 (95% CI = 0.3–1.2) among DAA-treated. Conclusions: People with HCV infection were at increased risk of liver cancer, hematologic cancer, and some other extrahepatic cancers. DAA treatment was associated with reduced risk of liver cancers and hematologic cancers. Impact: DAA treatment is important for reducing cancer incidence among people with HCV infection.

The incidence of all organ malignancies and overall survival of patient with sustained virological response of HCV

“…Furthermore, the risk of other organ carcinogenesis has been reported to persist after SVR. 22,23 For this reason, sorting of follow-up with a view only to hepatic carcinogenesis may be one-sided. In fact, in our study cohort, non-HCC malignancies, like HCC, had a linear curve of carcinogenesis and continued to develop at approximately the same rate up to 5 years.…”

“…19 Furthermore, it has been reported to be associated with B-cell non-Hodgkin's lymphoma, intrahepatic cholangiocarcinoma, pancreatic cancer, colorectal cancer, oral and pharyngeal cancer, and lung cancer, in addition to HCC. [20][21][22][23] However, the only prospective study that observed a population of patients who achieved SVR not only for the development of HCC but also for the development of other malignancies was the observation of 389 cases of SVR with interferon (IFN) treatment. 22 There are no prospective studies that have comprehensively observed overall malignancy development and life expectancy in a population of patients achieving SVR with DAA.…”

Cancer statistics forAmericanIndian andAlaskaNative individuals, 2022: Including increasing disparities in early onset colorectal cancer

“…To our knowledge, reasons for these elevated rates remain poorly understood. However, improving access to health care and antiviral medications among AIAN individuals is critical for reducing the burden of liver cancer 106 (for more information, see the section headed Hepatitis B virus and hepatitis C virus, below).…”

“…Consequently, the US Department of Health and Human Services has designated AIAN individuals as a priority population in its viral hepatitis action plan 175 . Part of that plan is improving access to new‐generation, direct‐acting antivirals, which became available in 2013 and can often clear established HCV infection, resulting in significantly improved outcomes, 176 including reduced liver cancer risk 106 . However, these drugs are expensive and unaffordable for many in the AIAN community because of the high prevalence of poverty and low insurance coverage (Table 1).…”

“…104 To our knowledge, reasons for these elevated rates remain poorly understood. However, improving access to health care and antiviral medications among AIAN individuals is critical for reducing the burden of liver cancer 106 (for more information, see the section headed Hepatitis B virus and hepatitis C virus, below). Liver cancer incidence and mortality have been increasing for decades in the United States, largely because of the HCV epidemic, which occurred primarily because of injection drug use and contaminated blood transfusions among people born between 1945 and 1965, before discovery of the virus in 1989.…”