The Impact of Hepatitis C Virus (HCV) Treatment with Direct-Acting (DAA) on the Incidence of Hepatocellular Carcinoma (HCC) in Patients with Advanced Liver Disease

Abstract

Background Use DAA has resulted in widespread eradication of Hepatitis C virus (HCV) infection in patients with advanced liver disease (ALD) compared with interferon (IFN)-based treatment era therapy. Recent reports have indicated an increased risk of hepatocellular carcinoma (HCC) associated with HCV treatment with DAA and/or after achieving sustained virologic response (SVR). Decreasing incidence of HCC has been reported for patients treated with IFN-based therapy who achieve SVR. Widespread HCV treatment with IFN-based therapy was started in 2006 at a single center. An interest exist whether there was an increase in HCC incidence after introduction of DAA therapy.Methods A single-center retrospective analysis of HCC incidence from 2009 to 2016 was conducted. Patients with HCC due to non-HCV-related diseases were included as unmatched controls. HCC cases were reviewed for HCV diagnosis, liver disease stage and evidence of prior HCV treatment. HCC rate was calculated using number of at risk patients with ALD who received HCV treatment each calendar year. Descriptive statistics were utilized for trend analysis. A total of 143 cases of HCC was identified between 2009 and 2016 with 110 cases of HCC in HCV patients. 727 at risk patients with ALD received treatment with antiviral therapy.ResultsThere was a progressive decrease in the number of incident HCC in HCV patients. The incidence rate of HCC in HCV patients declined from 23.1% in 2009 to 1.79% in 2016 in at risk patients receiving antiviral therapy. The HCC incidence rates in 2009, 2010, 2011, 2012, 2013, 2014, 2015, and 2016 was 23.1%, 14.3%, 60.0%, 22.2%, 6.25%, 1.48%, 1.11%, and 1.79% respectively. The number of HCC cases in non-HCV patients remain unchanged during the same period. One year HCC survival ranged from 75% to 90% in HCV patients and 38 to 100% in non-HCV patients with no trends in survival identified.Conclusion The incidence of HCC decreased in at risk HCV patients with ALD who received antiviral therapy with the largest decline occurring in patients who received DAA therapy. One year survival did not appear to change during the study period.Disclosures All authors: No reported disclosures.