Direct-acting antivirals do not raise HCC risk in hepatitis C patients
In patients with advanced hepatitis C infections, taking direct-acting antivirals (DAAs) does not increase the risk of subsequent hepatocellular carcinoma (HCC), a recent study has shown.
Researchers conducted a prospective study of 3,917 patients with hepatitis C infection who were taking DAAs (mean age 58.1±11.9 years; 62.2 percent male); only those with fibrosis stage ≥F3 were eligible for inclusion. Cox regression analyses were performed to identify risk factors for HCC development.
Over a mean follow-up of 536.2±197.6 days, 55 new cases of HCC were reported, yielding an overall incidence rate of 0.97 percent patients per year. The corresponding incidence rate in cirrhotic patients was 1.18 percent patients per year.
Multivariate analysis of baseline variables showed that coinfection with hepatitis B virus (hazard ratio [HR], 3.99; 95 percent CI, 1.24–12.91; p=0.021) and APRI (aspartate aminotransferase-to-platelet ratio) score >2.5 (HR, 2.03; 1.14–3.61; p=0.016) were significant and independent risk factors for HCC development.
In 55 patients who developed HCC (mean age 59.15±9.7 years; 37 males), all hepatitis C virus genotypes were present. The time from DAA initiation to HCC diagnosis ranged from 4–57 weeks and averaged 31.8±20.1 weeks. Twenty-two patients developed HCC while on DAA medication.
In relation to virological outcomes, those who experienced sustained virological response (SVR) were less likely to contract the aggressive form of HCC than in those without SVR (54.6 percent vs 12.1 percent). Moreover, the aggressive HCC pattern was more common during the early periods of observation, while the less aggressive form predominated during later follow-ups.