Affiliation:
1. Division of Gastroenterology and Hepatology University of Washington Seattle Washington USA
2. Division of Gastroenterology Veterans Affairs Puget Sound Health Care System Seattle Washington USA
3. Division of Gastroenterology and Hepatology The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
4. Lineberger Comprehensive Cancer Center The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
5. Hospital and Specialty Medicine Veterans Affairs Puget Sound Health Care System Seattle Washington USA
6. Division of General Internal Medicine University of Washington School of Medicine Seattle Washington USA
7. Health Service Research and Development Veterans Affairs Puget Sound Health Care System Seattle Washington USA
Abstract
SummaryBackgroundIt is unclear whether the risk of hepatocellular carcinoma (HCC) decreases over time following hepatitis C virus (HCV) eradication.AimTo determine if patients who have accrued longer time since sustained virologic response (SVR) have a lower risk of HCC than those with less time since SVRMethodsWe conducted a retrospective cohort study of all HCV‐infected Veterans Affairs patients who achieved SVR before 1 January 2018 and remained alive without a diagnosis of HCC as of 1 January 2019 (n = 75,965). We ascertained their baseline characteristics as of 1 January 2019 (time zero), including time accrued since SVR and followed them for the subsequent 12 months for incident HCC. We used multivariable Cox proportional hazards regression to determine the association between time since SVR and HCC risk after adjusting for age, race/ethnicity, sex, diabetes, hypertension, body mass index, alcohol use, Charlson Comorbidity Index, Fibrosis‐4 score, HCV genotype, hepatitis B virus co‐infection and HIV co‐infection.Results96.0% were male; mean age was 64.6 years. Among those with cirrhosis (n = 19,678, 25.9%), compared to patients who had accrued only ≥1 to 2 years since SVR (HCC incidence 2.71/100 person‐years), those who had accrued >2 to 4 years (2.11/100 person‐years, aHR 0.80, 95% CI 0.63–1.01) and >4 to 6 years (1.65/100 person‐years, aHR 0.61, 95% CI 0.41–0.90) had progressively lower HCC risk. However, HCC risk appeared to plateau for those with >6 years since SVR (1.68/100 person‐years, aHR 0.70, 95% CI 0.46–1.07). Among those without cirrhosis, HCC risk was 0.23–0.27/100 person‐years without a significant association between time since SVR and HCC risk.ConclusionsAmong patients with cirrhosis and cured HCV infection, HCC risk declined progressively up to 6 years post‐SVR—although it remained well above thresholds that warrant screening. This suggests that time since SVR can inform HCC surveillance strategies in patients with cured HCV infection and can be incorporated into HCC risk prediction models.
Funder
American Association for the Study of Liver Diseases
Health Services Research and Development
Subject
Pharmacology (medical),Gastroenterology,Hepatology
Cited by
8 articles.
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