
Non-Sponsored Content
HEPATITIS C VIRUS
Residual risk of hepatocellular carcinoma in older Hepatitis C patients even after viral clearance
Medical writer: Kirsty LEE | Last updated: 13th August 2020 | In: Gastrointestinal Cancer, Hepatitis C Virus, Infectious Disease, Oncology
Article Keywords
DAA, direct-acting antiviral agents, HCV, pegylated interferon-α, ribavirin
Infection with the hepatitis C virus (HCV) can lead to a chronic hepatitis C infection (CHC) and subsequent liver complications such as fibrosis, cirrhosis, end-stage liver disease, and hepatocellular carcinoma (HCC).1Mukherjee R et al. J Lab Autom. 2015;20(5):519-538. HCV infections are historically treated with pegylated interferon-α and ribavirin, but the advent of direct-acting antiviral agents (DAAs) over the past recent years has remarkably improved the sustained virological response (SVR) rates, defined as undetectable viral RNA for six months after treatment completion.2,32. Preciado MV et al. World J Gastroenterol WJG. 2014;20(43):15992-16013.
3. Jhaveri MA et al. Drugs Aging. 2018;35(2):117-122. Older patients are beginning to represent majority of outpatient cases for hepatitis C, due to the progressive aging of the HCV-infected population and fewer new cases.4Vespasiani-Gentilucci U et al. World J Gastroenterol WJG. 2015;21(24):7412-7426. Real world cohorts now show that almost all older patients are able to obtain similar virological outcomes with younger patients.5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359.
The results of a multicentre cohort study in Japan assessing the risk for HCC development in patients aged 75-84 years with CHC and without a history of HCC and who had achieved HCV elimination with DAAs were recently published in The Journal of Infectious Diseases.5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359. Data of 2,405 Japanese patients who received treatment with interferon-free DAA regimens for CHC between September 2014 and December 2019 were analysed. The primary endpoint was de novo incidence of HCC after achieving an SVR with DAA treatment.5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359. At the time of DAA initiation, 45.8% of patients were aged 60-74 and 20.8% of patients were aged 75-84.5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359. In the older group of 75-84, 34.8% were men, 27.2% had a diagnosis of cirrhosis, and 71.6% were treatment-naïve.5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359. Compared with patients aged 60-74, the older patients had lower serum albumin levels and were more likely to have experienced HCV treatment.5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359.
Overall, 64 patients developed HCC during the follow-up period from 1 year after initiation of DAAs.5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359. Multivariable analysis adjusting for background characteristics showed certain factors conferred a higher risk of HCC.5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359. Patients aged 60-74 years had over a quadruple risk of HCC development (HR=4.95; 95% CI: 1.57-15.6; p=0.006), and patients aged 75-84 even higher (HR=6.93; 95% CI: 2.00-24.0; p=0.002). Other predictive factors included male sex (HR=2.29; 95% CI: 1.25-4.18; p=0.007) and cirrhosis (HR=2.41; 95% CI: 1.40-4.15; p=0.002).5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359.
After propensity score matching between the 60-74 and 75-84 age groups, significant variables predicting HCC incidence were male sex (adjusted HR=2.62; 95% CI: 1.39-4.93; p=0.003), cirrhosis (adjusted HR=2.22; 95% CI: 1.03-4.75; p=0.04), and AFP level 12 weeks after treatment completion (>7ng/mL) (adjusted HR=2.80; 95% CI: 1.33-5.91; p=0.007).5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359. The Kaplan-Meier curve for age and cirrhosis status for the propensity-score matched cohort indicated that the 5-year cumulative incidence for HCC was significantly higher in the 75-84 age group than 60-74 (5.2% vs 1.3%, respectively; p=0.048).5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359.
The findings from this study suggest that patients aged ≥75 may remain at high risk for HCC, even after HCV clearance with DAAs.5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359. Regular monitoring of this patient population should be necessary for early detection of HCC.5Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359.
Reference
- Mukherjee R et al. J Lab Autom. 2015;20(5):519-538.
- Preciado MV et al. World J Gastroenterol WJG. 2014;20(43):15992-16013.
- Jhaveri MA et al. Drugs Aging. 2018;35(2):117-122.
- Vespasiani-Gentilucci U et al. World J Gastroenterol WJG. 2015;21(24):7412-7426.
- Ogawa E et al. J Infect Dis. DOI: 10.1093/infdis/jiaa359.
Disclaimer
This article is not medical advice. Patients should seek personal assessment by a licenced specialist. Physicians are recommended to read the full publication(s) as cited in the article before making medical decisions. This article does not supersede nor replace the published article(s).
© Copyright 2020 MediPaper Medical Communications Ltd. – Residual risk of hepatocellular carcinoma in older Hepatitis C patients even after viral clearance
YOU MAY ALSO LIKE



































































Venetoclax plus azacitidine, decitabine, or low-dose cytarabine FDA approved in elderly AML patients












































































































© Copyright 2020 MediPaper Medical Communications Ltd. – Residual risk of hepatocellular carcinoma in older Hepatitis C patients even after viral clearance
Leave a Reply
Want to join the discussion?Feel free to contribute!