A comprehensive study utilizing data from the US Department of Veterans Affairs healthcare system has demonstrated that direct-acting antiviral (DAA) therapy significantly reduces the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C virus (HCV)-related cirrhosis compared to untreated patients.
Treatment Outcomes and Risk Reduction
The study revealed that patients receiving DAA treatment showed a significantly lower risk of developing HCC compared to those who received no treatment, with a hazard ratio of 0.70 (95% CI, 0.65-0.74) in the multivariable Cox model. The crude incidence rate of HCC was 22.26 per 1000 person-years in DAA-treated patients, compared to 28.09 per 1000 person-years in untreated patients.
When compared to historical interferon (IFN) therapy, DAA treatment demonstrated comparable effectiveness in preventing HCC. The study found no significant difference in HCC risk between DAA and IFN treatments (HR, 0.98; 95% CI, 0.87-1.10), despite DAA's notably higher cure rates.
Study Population and Treatment Response
The research included a substantial cohort of patients:
- 27,147 patients received DAA treatment
- 6,809 patients received IFN treatment
- 53,847 patients contributed to untreated time
Treatment success rates showed marked differences between the two therapeutic approaches:
- DAA therapy: 89.39% achieved sustained virologic response (SVR)
- IFN therapy: 36.55% achieved SVR
Global Context and Clinical Implications
According to the World Health Organization, approximately 50 million people globally live with chronic HCV infection, with around 242,000 deaths recorded in 2022, primarily due to cirrhosis and HCC. While DAA therapy has revolutionized HCV treatment with cure rates exceeding 95%, patients who achieve SVR still face an elevated risk of developing HCC.
Expert Perspective
Dr. Jennifer Rosenthal Kramer and colleagues from Baylor College of Medicine emphasized the significance of these findings: "These findings strongly support the practice of offering DAA treatment to chronic HCV patients with cirrhosis and illustrate a favorable risk-benefit for DAA treatment in this vulnerable high-risk population as well as affirm the chemopreventive effect of DAA on de novo HCC risk."
Methodology and Data Collection
The retrospective cohort study examined patients aged 18 and older with chronic HCV infection and compensated cirrhosis. The research team identified de novo HCC cases through the VA Central Cancer Registry and ICD9/10 codes. The study period for DAA treatment spanned from January 2014 to December 2017, while the IFN treatment cohort was evaluated between January 2005 and December 2013.
