Apart from Hepatitis C cure, some patients still benefit from liver cancer screening

The risk of hepatocellular carcinoma (HCC) decreased but remained high enough to screen for in the first 7 years in some patients cured of their hepatitis C virus infections with direct-acting antivirals, a study has shown observational.

For patients with cirrhosis or high fibrosis 4 (FIB-4) scores who achieved a sustained virologic response, the risk of HCC persisted and warranted continued screening, reported George Ioannou, MD, MS, of Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues.

Although the annual incidence of HCC decreased from 3.8% in the first year to 1.4% in the seventh year after patients with an FIB-4 score ≥ 3.25 achieved a sustained virologic response, it still exceeded well below the 1% per year threshold that could be considered a cost. -efficient (PGastroenterology search letter.

Subgroup analyzes showed a higher incidence of HCC in patients with cirrhosis (1.0-4.5 per 100 patient-years), independent of any change in their FIB-4 score, than in those without. cirrhosis (0.3-2.2 per 100 patient-years), they added.

Over approximately 5 years of mean follow-up, more patients who had cirrhosis before treatment developed HCC over time compared to those without cirrhosis before treatment (12.6% versus 2.5%). For patients with cirrhosis and an FIB-4 score

“We still don’t know how much the risk of liver cancer decreases after the eradication of hepatitis C as time passes,” Ioannou said. MedPage today. “The most important take-home message is that patients who had already developed cirrhosis or had an FIB-4 greater than 3.25 before their hepatitis C was eradicated, should continue liver cancer screening ‘indefinitely.’ for the moment.”

Direct-acting antivirals can cure hepatitis C and reduce the risk of HCC, but there remains a significant risk of cirrhosis or advanced fibrosis in these patients, the authors noted.

Previous work by Ioannou’s group found that the annual incidence of HCC during the first 4 years after achieving a sustained virological response remained above 2% for those affected. cirrhosis before treatment and more than 1% for those without cirrhosis but with an FIB-4 score ≥3.25. Although this study showed a decrease in the annual risk of HCC, it could not confirm whether further HCC screening was warranted due to its short follow-up.

“This is an interesting article for two main reasons. First, it shows that the likelihood of developing HCC decreases but remains high for up to 7 years after getting HCV. [hepatitis C virus] cure,” said Andrew Talal, MD, of the University at Buffalo in New York, MedPage today. “Second, even in people without cirrhosis, the risk of developing HCV remains.”

“These two points argue in favor of continued screening for HCC in people with advanced liver disease and, especially, cirrhosis,” said Talal, who was not involved in this study.

The current study provided an extended 7-year follow-up of the previous cohort. It assessed electronic health record data from 29,033 VA patients with hepatitis C virus infections who achieved a sustained virologic response (with or without ribavirin) from January 2013 to December 2015. Of these- ci, 7,533 patients had cirrhosis before treatment and 21,500 did not. The follow-up took place until December 2021.

Almost all patients were male and 52% were Caucasian. The average age was 61 and the average BMI was 27-29. Common comorbidities included alcohol use disorders (44%), substance use disorders (38%) and diabetes (29%).

In the group with cirrhosis prior to treatment, those with an FIB-4 score ≥ 3.25 experienced their lowest incidence of HCC at their 7-year follow-up and in 2020, which may be caused by the impact of COVID -19, the researchers said. .

Among the group without cirrhosis before treatment, 4682 had an FIB-4 score ≥ 3.25 at baseline. The incidence of HCC was significantly higher for those with this higher FIB-4 score than for those with a lower score (1.2 versus 0.2 per 100 patient-years). Notably, patients who lowered their FIB-4 score from ≥ 3.25 before treatment to less than this threshold after treatment had a lower incidence of HCC than those with a continuously high score (1.0 versus 2.2 per 100 patient-years).

Limitations of the study included the fact that all participants were veterans and follow-up was extended during the pandemic.

“These early findings require validation in non-veteran cohorts and with follow-up that extends beyond the COVID-19 pandemic, when hopefully HCC screening and diagnostic practices will return to normal,” the authors said.

  • Zaina Hamza is a writer for MedPage Today, covering gastroenterology and infectious diseases. She is based in Chicago.

Disclosures

The study was supported by the NIH, the National Cancer Institute, and Veterans Affairs Clinical Science Research and Development.

Ioannou and his co-authors have disclosed no relationship with the industry.

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