HCV eradication induced by direct-acting antiviral agents reduces the risk of hepatocellular carcinoma

Ioannou, George N.; Green, Pamela K.; Berry, Kristin

doi:10.1016/j.jhep.2017.08.030

Cited by 469 publications

(486 citation statements)

References 31 publications

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“…Toyoda et al [43] reported that the annual incidence of HCC after an SVR among patients receiving an IFN-free therapy may be more than 2-fold higher than that among patients achieving an SVR via an IFN-based therapy. More recently, Ioannou et al [44] published data from the United States Veterans database of HCV-infected patients treated with either IFN and/or DAAs. In this study, de novo HCC was observed in 1–3/100 person-years across the different cohorts and, consistent with our findings, the authors reported a significant decrease in HCC risk following an SVR.…”

Section: Discussionmentioning

confidence: 99%

Risk of de novo Hepatocellular Carcinoma after HCV Treatment with Direct-Acting Antivirals

et al. 2018

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Background and Aims: The aim of the study was to evaluate the risk of hepatocellular carcinoma (HCC) development after treatment with direct-acting antivirals (DAAs) and to compare HCC occurrence in these patients with that among patients treated with interferon (IFN)-based therapies. Methods: We analyzed a large cohort with chronic hepatitis C virus patients for the onset of new HCC after DAA treatment. A historical IFN-treated cohort was investigated for comparison. Results: A total of 819 patients were included in the DAA group. The median follow-up period was 263 days (0–1,001). Twenty-five patients (3.6 HCCs/100 person-years; 3.1%) were diagnosed with de novo HCC within the time of observation. No patient without cirrhosis had developed HCC. Patients with newly diagnosed HCC were mostly male, older, and treatment-experienced and had a lower 12-week sustained virologic response (SVR12) rate and higher levels of liver inflammation markers. The median time to HCC was 312 days (0–880). Investigation of the subcohort of 269 cirrhotic patients yielded an HCC rate of 8.9 HCCs/100 person-years. In this cohort, non-SVR12 was an independent risk factor for de novo HCC (HR 4.48; 95% CI 1.51–13.12; p = 0.007). Twenty-four patients (96%) with new HCC were Child-Pugh class A and 17 (68%) were diagnosed in early BCLC stage A. For the IFN-treated patients, we calculated an overall risk of HCC occurrence of 1.3/100 person-years (19 patients out of 351; 5.4%). The median time to diagnosis was 38.8 months (0–113). Conclusion: The de novo HCC rates did not differ between the DAA-treated patients and those who received IFN. Achievement of SVR is of utmost importance for HCC prevention.

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Section: Discussionmentioning

confidence: 99%

Risk of de novo Hepatocellular Carcinoma after HCV Treatment with Direct-Acting Antivirals

et al. 2018

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“…A large retrospective cohort study of Veterans Affairs (VA) patients demonstrated that DAA-induced SVR significantly reduces the incidence of HCC. Out of 21,948 DAA-treated patients followed for a mean of approximately 2 years, the incidence of HCC in patients who achieved SVR was 0.92 per 100 patient-years versus 5.19 per 100 patient-years in patients who failed treatment (9). The associated hazard ratio (HR) for HCC was 0.29 (95% CI 0.23–0.37) after adjusting for demographic characteristics, cirrhosis, HCV genotype and viral load, HBV or HIV co-infection, and liver-related laboratory parameters.…”

Section: Daa Treatment and De Novo Hccmentioning

confidence: 99%

The Impact of Direct-acting Antiviral Therapy for Hepatitis C on Hepatocellular Carcinoma Risk

Ioannou

2018

Curr Hepatology Rep

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Purpose of review Direct-acting antiviral agents (DAAs) eradicate hepatitis C virus (HCV) infection in the majority of patients. We critically evaluated the impact of DAAs on hepatocellular carcinoma (HCC) risk, a major complication of HCV infection. Recent findings Large cohort studies show that patients who achieve sustained virologic response (SVR) with DAAs have a significantly lower risk of developing de novo HCC than patients who fail treatment or remain untreated. Furthermore, reduction in HCC risk is similar whether SVR is achieved with DAAs or interferon (IFN). However, DAA-induced SVR does not eliminate HCC risk entirely. Therefore, patients with pre-existing cirrhosis require ongoing surveillance even after SVR is achieved. Early, descriptive, uncontrolled reports suggested that DAAs may increase the risk of recurrent HCC. While studying HCC recurrence presents major methodologic challenges, larger studies containing appropriate comparison control groups largely refuted these concerns. Summary Recent studies provide evidence that DAA-induced SVR reduces HCC risk.

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“…These data were confirmed in a recent study involving patients treated with DAA. Results from this study showed that risk for HCC was similarly and significantly reduced in patients who achieved SVR after IFN monotherapy (HR 0.32; 95% CI, 0.28-0.37), DAA + IFN (HR 0.48; 95% CI, 0.32-0.73) or DAA-ONLY (HR 0.29; 95% CI, 0.23-0.37) (12).…”

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confidence: 71%

Direct acting antiviral agents and hepatocellular carcinoma development: don’t take it for granted

Buonomo

Gentile

Borgia

2017

Transl. Gastroenterol. Hepatol.

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HCV eradication induced by direct-acting antiviral agents reduces the risk of hepatocellular carcinoma

Abstract: It was unclear whether direct-acting antiviral treatment-induced sustained virologic response reduces the risk of liver cancer in patients with HCV infection. We demonstrated that eradication of HCV infection with direct-acting antiviral agents reduces the risk of liver cancer by 71%.

Cited by 469 publications

References 31 publications

Risk of de novo Hepatocellular Carcinoma after HCV Treatment with Direct-Acting Antivirals

Risk of de novo Hepatocellular Carcinoma after HCV Treatment with Direct-Acting Antivirals

The Impact of Direct-acting Antiviral Therapy for Hepatitis C on Hepatocellular Carcinoma Risk

Direct acting antiviral agents and hepatocellular carcinoma development: don’t take it for granted

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