Incidence of Hepatocellular Carcinoma After Direct Antiviral Therapy for HCV in Patients With Cirrhosis Included in Surveillance Programs

Abstract

Analysis of data from the ANRS CO12 CirVir cohort reveals that the apparent increase in HCC incidence observed in patients with cirrhosis treated with DAAs compared with patients who achieved SVR following an IFN therapy can be explained by patient characteristics (age, diabetes, reduced liver function) and lower screening intensity.

Serum sphingolipids predict de novo hepatocellular carcinoma in hepatitis C cirrhotic patients with sustained virologic response

“…However, as we have recently shown, there is a growing body of evidence that HCC occurrence and recurrence rates do not increase but even decrease following DAA therapy and are comparable to those reported in the IFN era . Nahon et al recently pointed out, that age, diabetes and reduced liver functions, as well as different screening intensity can explain the apparent increase of HCC incidence in patients after DAA‐therapy compared to patients who received IFN therapy . In line with these published data our current results on SL courses and changes show lower concentrations of serum SLs at FU12 than compared to BL after DAA therapy.…”

“…,42 Nahon et al recently pointed out, that age, diabetes and reduced liver functions, as well as different screening intensity can explain the apparent increase of HCC incidence in patients after DAA-therapy compared to patients who received IFN therapy 43. In line with these published data our current results on SL courses and changes show lower concentrations of serum SLs at FU12 than compared to BL after DAA…”

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

“…Eradicating hepatitis C infection results in numerous health benefits, including reduced rates of all‐cause mortality, cirrhosis, hepatic decompensation, and HCC . Successful treatment also confers improvement in extrahepatic manifestations of HCV disease, including cryoglobulinemic vasculitis and HCV‐related non‐Hodgkin lymphoma and other lymphoproliferative disorders, as well as improved productivity and quality of life .…”

“…Eradicating hepatitis C infection results in numerous health benefits, including reduced rates of allcause mortality, cirrhosis, hepatic decompensation, and HCC. (33,37,(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108)(109)(110) Successful treatment also confers improvement in extrahepatic manifestations of HCV disease, including cryoglobulinemic vasculitis (111)(112)(113)(114)(115)(116) and HCV-related non-Hodgkin lymphoma and other lymphoproliferative disorders, (117)(118)(119)(120)(121)(122)(123)(124)(125) as well as improved productivity and quality of life. (34,35,(126)(127)(128)(129)(130)(131) Given these and other benefits associated with virologic cure, the HCV guidance panel strongly recommends antiviral treatment for all adults with acute or chronic HCV infection (except those with a short life expectancy that cannot be remediated).…”

Direct‐acting antivirals and the risk of hepatocellular carcinoma: The end of a polemic?

“…In addition to these important results, methodological limitations have been pointed out for some studies suggesting a higher risk of de novo HCC or HCC recurrence as well as a higher aggressiveness. Moreover, several retrospective or prospective studies did not confirm such a risk. A systematic review, meta‐analysis and meta‐regression of 26 studies (IFN‐based regimen = 17, oral DAAs = 9) did not confirm a significant risk of both HCC occurrence and recurrence associated with DAA …”