Declining incidence of hepatitis C related hepatocellular carcinoma in the era of interferon‐free therapies: A population‐based cohort study

Innes, Hamish; McDonald, Scott; Hamill, Victoria; Yeung, Alan; Dillon, John; Hayes, Peter; Went, April; Fraser, Andrew; Bathgate, Andrew; Barclay, Stephen T.; Janjua, Naveed Z.; Goldberg, David J.; Hutchinson, Sharon

doi:10.1111/liv.15143

Cited by 10 publications

(12 citation statements)

References 23 publications

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“…Patients with HCV infection in the United States are mainly men, concentrated in middle-aged and elderly people according to our age structure analysis, probably because of the baby boomers. This may explain their higher ASMR and ASDR as male and older age both affect the prognosis of liver cirrhosis and liver cancer (16,32,41). In addition, decomposition analysis also found that the increase in DALYs and deaths related to HCV infection in the United States was mainly due to the increase in age-specific DALYs and deaths, which was almost equal to the sum of the contributions of population growth and aging.…”

Section: Discussionmentioning

confidence: 96%

The burden of hepatitis C virus in the world, China, India, and the United States from 1990 to 2019

Yang

Wang

et al. 2023

Front. Public Health

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Background and aimHepatitis C virus infection can lead to an enormous health burden worldwide. Investigating the changes in HCV-related burden between different countries could provide inferences for disease management. Hence, we aim to explore the temporal tendency of the disease burden associated with HCV infection in China, India, the United States, and the world.MethodsDetailed data on the total burden of disease related to HCV infection were collected from the Global Burden of Disease (GBD) 2019 database. Joinpoint regression models were used to simulate the optimal joinpoints of annual percent changes (APCs). Further analysis of the age composition of each index over time and the relationship between ASRs and the socio-demographic Index (SDI) were explored. Finally, three factors (population growth, population aging, and age-specific changes) were deconstructed for the changes in the number of incidences, deaths, and DALYs.ResultsIt was estimated that 6.2 million new HCV infections, 0.54 million HCV-related deaths, and 15.3 million DALYs worldwide in 2019, with an increase of 25.4, 59.1, and 43.6%, respectively, from 1990, are mainly due to population growth and aging. China experienced a sharp drop in age-standardized rates in 2019, the United States showed an upward trend, and India exhibited a fluctuating tendency in the burden of disease. The incidence was increasing in all locations recently.ConclusionHCV remains a global health concern despite tremendous progress being made. The disease burden in China improved significantly, while the burden in the United States was deteriorating, with new infections increasing recently, suggesting more targeted interventions to be established to realize the 2030 elimination goals.

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Section: Discussionmentioning

confidence: 96%

The burden of hepatitis C virus in the world, China, India, and the United States from 1990 to 2019

Yang

Wang

et al. 2023

Front. Public Health

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“…In addition, though previous population-based study showed a reduction in HCC mortality in the IFN-free era, 41 the prognosis of HCV-related HCC remains suboptimal in the IFN-free era, and a "precision medicine" approach to HCC screening may be adopted to improve the prognosis. 42 The non-responders, who have worse survival than patients with SVR, should be monitored closely to detect early recurrence. In addition, the lower incidence of HCC in IFN-free era needs more targeted approach to HCC surveillance to identify early HCCs, and new risk prediction tools are needed to support this approach.…”

Section: Discussionmentioning

confidence: 99%

“…In our analysis, DAAs showed the trend to improve OS over IFN for HCV‐ related HCC, but this result needs further verification because it is based on non‐randomized comparisons from limited studies. In addition, though previous population‐based study showed a reduction in HCC mortality in the IFN‐free era, 41 the prognosis of HCV‐related HCC remains suboptimal in the IFN‐free era, and a “precision medicine” approach to HCC screening may be adopted to improve the prognosis 42 . The non‐responders, who have worse survival than patients with SVR, should be monitored closely to detect early recurrence.…”

Section: Discussionmentioning

confidence: 99%

Clinical benefits of direct‐acting antivirals therapy in hepatitis C virus patients with hepatocellular carcinoma: A systematic review and meta‐analysis

Liu

Yang

Dong

et al. 2022

J of Gastro and Hepatol

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Background and Aim:The purpose of the present study was to evaluate the effect of direct-acting antivirals (DAAs) therapy on the clinical outcomes of hepatitis C virus (HCV) patients with hepatocellular carcinoma (HCC). Methods: We searched multiple electronic databases from database inception to June 14, 2021. Meta-analyses were performed separately for HCC recurrence and overall survival (OS). Results: A total of 23 studies were identified for the primary analysis. Compared with no intervention, pooled data showed significant benefit from DAAs therapy in reducing recurrence (adjusted HR = 0.55, 95% CI 0.41-0.74, P < 0.001; I 2 = 66.6%, P < 0.001) and improving OS (adjusted HR = 0.36, 95% CI 0.16-0.83, P = 0.017; I 2 = 90.7%, P < 0.001) of HCV-related HCC patients. Compared with non-responders, patients with sustained virologic response (SVR) had greater benefit from DAAs therapy in reducing recurrence (HR = 0.37, 95% CI 0.16-0.84, P = 0.017; I 2 = 58.8%, P = 0.088) and improving OS (HR = 0.17; 95% CI 0.06-0.50; P = 0.001; I 2 = 56.4%, P = 0.130). Though DAAs did not show significant advantages over IFN in reducing recurrence (adjusted HR = 0.96, 95% CI 0.72-1.28, P = 0.784; I 2 = 0.0%, P = 0.805), there seems to be a trend toward OS benefit from DAAs therapy (adjusted HR = 0.11, 95% CI 0.01-1.19, P = 0.059). Conclusion: DAAs therapy can prevent recurrence and improve OS of HCV-related HCC patients, especially for patients with SVR. Further prospective randomized controlled trial is warranted to validate these results.

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“…Thus, because the majority of HCCs are not detected until an advanced stage, only about 4 patients in 10 go onto be treated with curative intent in the UK and other countries. 1,6 Clinical guidelines recommend individuals with cirrhosis should receive biannual ultrasound (US) of the liver/abdomen to maximise early HCC detection. [7][8][9] However, a recent systematic review reported that only 9.8% of cirrhosis patients receive biannual US surveillance, based mainly on data from North America.…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, suitability for these treatment hinges on early HCC detection. Thus, because the majority of HCCs are not detected until an advanced stage, only about 4 patients in 10 go onto be treated with curative intent in the UK and other countries 1,6 …”

Section: Introductionmentioning

confidence: 99%

Delivery of biannual ultrasound surveillance for individuals with cirrhosis and cured hepatitis C in the UK

Hamill

Gelson

MacDonald

et al. 2023

Liver International

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Background: Previous studies show the uptake of biannual ultrasound (US) surveillance in patients with cirrhosis is suboptimal. Here, our goal was to understand in broader terms how surveillance is being delivered to cirrhosis patients with cured hepatitis C in the UK. Methods: Hepatitis C cirrhosis patients achieving a sustained viral response (SVR)to antiviral therapies were identified from the national Hepatitis-C-Research-UK resource. Data on (i) liver/abdominal US examinations, (ii) HCC diagnoses, and (iii) HCC curative treatment were obtained through record-linkage to national health registries.The rate of US uptake was calculated by dividing the number of US episodes by follow-up time.Results: A total of 1908 cirrhosis patients from 31 liver centres were followed for 3.8

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Declining incidence of hepatitis C related hepatocellular carcinoma in the era of interferon‐free therapies: A population‐based cohort study

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 10 publications

References 23 publications

The burden of hepatitis C virus in the world, China, India, and the United States from 1990 to 2019

The burden of hepatitis C virus in the world, China, India, and the United States from 1990 to 2019

Clinical benefits of direct‐acting antivirals therapy in hepatitis C virus patients with hepatocellular carcinoma: A systematic review and meta‐analysis

Delivery of biannual ultrasound surveillance for individuals with cirrhosis and cured hepatitis C in the UK

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