Clinical Impact of Viral Load on the Development of Hepatocellular Carcinoma and Liver-Related Mortality in Patients with Hepatitis C Virus Infection

Abstract

Aim. This study aimed to assess clinical impact of hepatitis C viral load on the development of hepatocellular carcinoma (HCC) and liver-related mortality in HCV-infected patients. Methods. A total of 111 subjects with chronic HCV infection who were available for serum quantitation of HCV RNA were recruited in this retrospective cohort. Cox-proportional hazards models were used to calculate hazard ratio (HR) of developing HCC and liver-related mortality according to serum HCV RNA titers. Results. HCC was developed in 14 patients during follow-up period. The cumulative risk of HCC development was higher in subjects with high HCV RNA titer (log HCV RNA IU/mL > 6) than subjects with low titer (log HCV RNA IU/mL ≦ 6) (HR = 4.63, P = 0.032), giving an incidence rate of 474.1 and 111.5 per 10,000 person-years, respectively. Old age (HR = 9.71, P = 0.014), accompanying cirrhosis (HR = 19.34, P = 0.004), and low platelet count (HR = 13.97, P = 0.009) were other independent risk factors for the development of HCC. Liver-related death occurred in 7 patients. Accompanying cirrhosis (HR = 6.13, P = 0.012) and low albumin level (HR = 9.17, P = 0.002), but not HCV RNA titer, were significant risk factors related to liver-related mortality. Conclusion. Serum HCV RNA titer may be considered an independent risk factor for the development of HCC but not liver-related mortality.

A potential clinical based score in hepatitis C virus cirrhotic patients to exclude small hepatocellular carcinoma

“…In a recent prospective study of the ANRS CO12 CirVir cohort including 1323 patients with HCV cirrhosis, Ganne-Carrié et al [44] found five variables independently associated with HCC development at 1, 3, and 5 years: age > 50 years, past excessive alcohol intake, GGT above the upper limit of normal, absence of SVR during follow-up and platelets < 100,000/mm 3 . The latter was also evidenced in our work and in the retrospective study by Noh et al [45] as a predictor of HCC.…”

Evaluation of HCV-associated Hepatocellular Carcinoma based on Alpha-fetoprotein levels

“…This study also evaluated the accuracy of the high AFP in prediction of HCC recurrence, based on the cutoff value of the median (302.5ng/mL), values higher than 302.5ng/mL had higher sensitivity, specificity and positive predictive value compared to those with lower AFP values. From this study, it is apparent that high HCV viraemia was correlated with the occurrence of HCC, which is consistent with that reported by Ran Noh et al; 2016 who revealed that HCV viral load is considered risk factor for the development of HCC [15]. Also, in this study high HCV viraemia was associated with higher AFP-secreting HCC.…”

Factors predicting hepatocellular carcinoma in hepatitis C infection

“…The cumulative risk of HCC development is higher in subjects with high HCV RNA titer than subjects with low titer [45] . SVR results in significantly more favorable long-term outcomes, and decreased risk of progression to cirrhosis and HCC [13,57] .…”

“…Moreover, liver cirrhosis, high AST to platelet ratio index (APRI) levels, and IL28B rs12979860 at baseline are all associated with HCC development in patients without sustained virological response (SVR) after peg-IFN combination therapy [42] . Even with SVR, the absolute risk of HCC is high in patients with established cirrhosis [1,8,9,12,[43][44][45][46] .…”