Development of hepatocellular carcinoma in patients with chronic hepatitis C who had sustained viral response following direct-acting antiviral therapy

Berat Ebik; Mustafa Aygan; Elif Tugba Tuncel; Huseyin Kacmaz; Nazim Ekin; Medeni Arpa; Kendal Yalcin

doi:10.14744/hf.2022.2022.0016

Development of hepatocellular carcinoma in patients with chronic hepatitis C who had sustained viral response following direct-acting antiviral therapy

Hepatol Forum. 2022 Sep 23;3(3):82-87. doi: 10.14744/hf.2022.2022.0016. eCollection 2022 Sep.

Authors

Berat Ebik¹, Mustafa Aygan², Elif Tugba Tuncel³, Huseyin Kacmaz⁴, Nazim Ekin¹, Medeni Arpa⁵, Kendal Yalcin⁶

Affiliations

¹ Department of Gastroenterology, University of Health Sciences, Diyabakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkiye.
² Deparment of Internal Medicine, Dicle University School of Medicine, Diyarbakir, Turkiye.
³ Department of Gastroenterology, Ministry of Health Manisa City Hospital, Manisa, Turkiye.
⁴ Department of Gastroenterology, Adiyaman Training Hospital, Adiyaman; Turkiye.
⁵ Department of Biochemistry, Recep Tayyip Erdogan University Schoool of Medicine, Rize, Turkiye.
⁶ Deparment of Gastroenterology, Dicle University School of Medicine, Diyarbakir, Turkiye.

Abstract

Background and aim: Several studies have suggested that treatment with direct-acting antivirals (DAAs) in patients with chronic hepatitis C virus (HCV) may be associated with an increased risk of developing hepatocellular carcinoma (HCC). We investigated the incidence and risk factors of HCC in HCV patients who achieved a sustained virologic response (SVR) following DAA therapies.

Materials and methods: The medical data of patients who were diagnosed with HCV and received DAA therapy in two tertiary centers in Turkey were retrospectively collected.

Results: Among them, 75 patients (52.4%) were noncirrhotic and 68 patients (47.6%) were cirrhotic. The overall SVR rate was 97.2% (139/143). It was 100% in noncirrhotic and 94.1% in cirrhotic patients. HCC was developed in 5 (7.4%) patients, all of whom had baseline cirrhosis. The annual rate of HCC occurrence was 2.94%, and the 5-year cumulative incidence of HCC was 7.3%. The mean Child-Pugh score (CPS) and Model for End-Stage Liver Disease (MELD) score significantly decreased after DAA treatment (CPS 7.0 vs 5.9, p=0.001; MELD 10.8 vs 9.5, p=0.003).

Conclusion: There was no significant increase in the rate of HCC in cirrhotic HCV patients treated with DAAs. This treatment led to a remarkably high SVR rate and lowered CPS and MELD scores in cirrhotic HCV patients.

Keywords: Chronic Hepatitis C infection; direct-acting antiviral agents; hepatocellular carcinoma.