The risk of developing hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) who achieved sustained virologic response (SVR) after completion of antiviral therapy has been assessed in a recent study entitled, “Incidence and predictors of hepatocellular carcinoma following sustained virological response: A national cohort study,” presented during the 2015 American Association for the Study of Liver Diseases (AASLD) annual meeting.
As a clinical definition, sustained virologic response (SVR) is applied to HCV patients that, following successful antiviral therapy, have undetectable virus levels in the blood after 24 weeks. Upon achieving this status, patients are considered cured of HCV. When left untreated, HCV can lead to serious problems such as cirrhosis and HCC, a risk association that has been thoroughly studied. However, the risk of developing these conditions in patients that have reached a cured status is not well known.
Researchers from the Houston VA Medical Center and Baylor College of Medicine (Houston, Texas) examined the records of patients that had reached SVR with interferon-based therapy and had at least a year of medical follow-up. The scientists found a total of 10,738 patients with no development of HCC before SBR. Of these, 100 developed HCC after SVR.
According to the results, the risk of developing HCC after SVR has an overall incidence of 0.33 percent per year, with diabetes, old age (65 years or older) and cirrhosis at the time of SVR identified as factors contributing for the annual risk of HCC. However, the researchers note that these conclusions were drawn from a group of patients mainly composed of male veterans treated with interferon-based treatments, so generalization to other groups of patients and other types of treatments, such as direct acting antivirals (DAAs), is not advised. Further research in a more diverse clinical and demographic group could allow the identification of effective prognostic markers.
Dr El-Serag, principal investigator of the study, commented on the significance of the study in a press release, stating: “We will be facing large numbers of cured HCV patients and this study gives us a glimpse what the clinical course might be. It is clear that while cure considerably reduces HCC risk in general, it does not eliminate it especially when cirrhosis is present and in those who get cured at an old age. Therefore, the sooner we cure patients the better off we are. Furthermore continued vigilance and HCC surveillance is warranted after cure in these subgroups.”