Risk for Hepatocellular Carcinoma with Cirrhosis After HCV Eradication

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To analyze changes in HCC annual incidence over time, following HCV eradication, dynamic markers of HCC Risk were identified. A total of 48,135 patients who initiated HCV antiviral treatment from 2000 through 2015 and achieved an SVR in the Veterans Health Administration and 29,033 were treated with direct-acting antiviral agents (DAA), with 19,102 treated with Interferon-based regimens. Patients were followed after treatment until 2/14/2019 (average 5.4 years), during which 1509 incident HCCs were identified.

Among patients with cirrhosis before treatment with DAAs (9784), those with pre-SVR FIB4 scores greater than 3.25 had a higher annual incidence of HCC (3.66 %/year), than those with FIB scores less than 3.25 (adjusted hazard ratio 2.14). In DAA-treated patients with cirrhosis and FIB scores greater than 3.25, annual HCC risk decreased from 3.8% per year in the first year after SVR to 2.4% per year by the 4th year. In Interferon-treated patients with FIB-4 scores greater than 3.25, annual HCC risk remained above 2% per year, even 10 years after SVR. A decrease in FIB scores from greater than 3.25 to less than 3.25 post SVR was associated with approximately 50% lower risk of HCC, but the absolute annual risk remained above 2% per year. Patients without cirrhosis before treatment (N = 38,351), had a low risk of HCC, except for those with pre-SVR FIB scores greater than 3.25 and post SVR FIB scores greater than 3.25. Risk remained high for many years after SVR.

It was concluded that patients with cirrhosis before an SVR to treatment for HCV infection continue to have high risk for HCC (greater than 2% per year) for many years, even if their FIB-4 score decreases, and surveillance should continue. Patients without cirrhosis, but with FIB scores greater than 3.25 have a high enough risk to merit HCC surveillance, especially if the FIB-4 remains greater than 3.25 post SVR.

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