- Although HCV clearance with direct-acting antivirals (DAAs) significantly reduces risk for de novo hepatocellular carcinoma (HCC), the effect is attenuated in patients with advanced fibrosis.
Why this matters
- Findings support guidelines for continued surveillance.
- Prospective multicenter Latin American cohort study involving 1400 patients treated with HCV DAAs; 72.5% had F3-F4 fibrosis and 56.0% were cirrhotic.
- Abdominal ultrasound was performed every 6 months.
- Funding: Argentina National Institute of Cancer, and LALREAN (AbbVie, Bristol-Myers Squibb).
- 91.4% (n=1280) completed the DAA regimen.
- Sustained virologic response (SVR) rate (n=1149 with data): 96.9%.
- 30 HCC cases were diagnosed over a median 16 months from DAA initiation (median time to diagnosis, 7.9 months).
- Cumulative HCC incidence overall and with cirrhosis:
- 12 months: 2% (95% CI, 1%-3%) and 3% (95% CI, 2%-5%).
- 24 months: 4% (95% CI, 3%-6%) and 6% (95% CI, 4%-8%).
- Non-SVR was tied to an ~5-fold increased risk for HCC (HR=4.9; P=.011) after adjusting for diabetes, prior interferon failure, Child-Pugh stage, and clinically significant portal hypertension (CSPH).
- CSPH was the strongest predictor of HCC (HR=9.1; P<.0001>
- SVR reduced relative risk for HCC by 73% (95% CI, 15%-91%).
- Persons needed to treat/case reduced: 17.
- Short follow-up.
- Potential preexisting HCC not captured.