History of hepatocellular carcinoma increases risk of liver-related death after SVR

Patients with a history of hepatocellular carcinoma face greater liver-related death after achieving a sustained virological response (SVR) to direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV), results of a prospective study show risk.

Yuki Tahata, Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan, presented results at the 2023 Liver Meeting of the American Association for the Study of Liver Diseases (AASLD), showing that older age, a history of hepatocellular carcinoma, and white blood at the time of SVR Decreased protein levels were significantly associated with liver-related mortality after SVR.¹

“Direct-acting antiviral therapy enables sustained virologic responses in nearly all HCV patients, including those with decompensated cirrhosis, and improves outcomes in patients with SVR. However, factors associated with long-term outcomes after SVR are not yet known. clear,” the researchers wrote.¹

The World Health Organization estimates that 58 million people have chronic HCV, with approximately 1.5 million new infections each year. Although there is currently no effective vaccine against HCV, DAA can cure more than 95% of people infected with hepatitis C and help them achieve SVR. However, little is known about factors associated with long-term prognosis after SVR.²

To identify risk factors associated with long-term prognosis based on liver and non-liver-related deaths in patients who achieved SVR after DAA therapy, the researchers recruited 3,238 patients who started DAA therapy between September 2014 and June 2021 and were hospitalized in Japanese hospitals. HCV patients achieving SVR. Patients who developed hepatocellular carcinoma before SVR were excluded from the study. SVR was defined as undetectable serum HCV-RNA 24 weeks after the end of treatment, and the study observation period began when SVR was confirmed.¹

Researchers used Cox proportional hazards analysis to examine factors associated with liver-related and non-liver-related death after SVR. Liver-related death was defined as death from hepatocellular carcinoma, liver failure, or variceal rupture.¹

In this cohort, the mean age was 69 years and 43% of participants were male. The researchers noted that 9% of patients had a history of HCC and 18% had cirrhosis. The median follow-up time after reaching SVR was 50.4 months, during which 24 participants died from liver-related causes, including hepatocellular carcinoma (n = 20), liver failure (n = 3), and variceal rupture ( n = 1). An additional 103 participants died from non-liver-related causes, with the most common causes of death being malignancies other than hepatocellular carcinoma (n = 20), cerebrovascular and cardiovascular events (n = 14), and infection (n = 12). .¹

The researchers noted that patients with a history of hepatocellular carcinoma (46%) were significantly more likely to die from liver-related causes than patients without a history of hepatocellular carcinoma (11%; ask < .001). Among participants with a history of hepatocellular carcinoma, annual liver-related mortality rates were 1.5%, 1.3%, and 3.6% at 3, 4, and 5 years after SVR, respectively.¹

In multivariate analysis, older age (ask = .008), history of hepatocellular carcinoma (ask = .002), and albumin levels decrease during SVR (ask = .014) was significantly associated with liver-related mortality after SVR, whereas older age (ask < .001), males (ask = .006), and albumin levels were lower at SVR (ask

< 0.001) was significantly associated with non-liver-related mortality after SVR.¹

“For patients with a history of HCC, the risk of liver-related death persists in the long term after SVR,” the researchers concluded.¹

refer to:

1. Hikita H, Nozaki Y, Ishida H, et al. 54: Long-term risk of liver-related and non-liver-related death in patients with hepatitis C virus following sustained virological response mediated by direct-acting antiviral agents. Paper presented at: Liver Conference. Boston, MA. November 10-14, 2023.
2. World Health Organization. Hepatitis C Newsroom. July 18, 2023. Accessed 13 November 2023. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c