Incidence and Factors of Hepatocellular Carcinoma in Hepatitis C Virus Patients Achieving Sustained Virological Response After Direct-Acting Antiviral Treatment
DOI:
https://doi.org/10.24871/253202424-31Keywords:
Direct-Acting Antiviral, Hepatitis C Virus, Hepatocellular Carcinoma, Incidence, Sustained Virological ResponseAbstract
Background: The incidence and risk factors for Hepatocellular Carcinoma (HCC) in Hepatitis C Virus (HCV) patients who have achieved Sustained Virological Response (SVR) after Direct-Acting Antiviral (DAA) therapy are not well established. Considering there are differences in DAA types, virus genotypes, and patient profiles in Indonesia, this study was conducted to assess the incidence and factors influencing HCC in HCV patients after SVR post DAA therapy. The objective of this study to determine the incidence and factors influencing HCC in HCV patients achieving SVR after DAA treatment.Methods: Retrospective cohort study conducted at Cipto Mangunkusumo National General Hospital, sample of HCV patients had SVR after DAA therapy in 2017 – 2019, followed until 2024. Patients were screened for abdominal ultrasound, alpha-fetoprotein (AFP) and 3-phase abdominal CT scan, if indicated. Descriptive, bivariate analysis with Fisher's exact, and multivariate analysis with logistic regression were conducted.Results: Among 180 subjects, the incidence and incidence ratio of HCC is 4.4% (0.91/100PY). Significant correlation in bivariate analysis from the variables liver cirrhosis (RR 10.5; CI 95% (1. 32 – 83.5); p = 0.0073) and type 2 DM (RR 8.47; CI 95% (2, 3 – 31.1) p = 0.0048). In multivariate analysis, there was significant correlation from type 2 DM variable (aRR 3.1; CI 95% (0.86 – 3.83); p=0.002).Conclusion: The incidence of HCC reaches 4.4% of the total population. Type 2 DM has significant correlation with the incidence of HCC in HCV patients who achieve SVR after DAA treatment.ÂReferences
Jessica Howell AJT. Hepatocellular carcinoma after sustained virologic response: leave no one behind. Gastroenterology. 2017;152(6):1282-4.
D HM. Epidemiology of Hepatitis B and C in Republic of Indonesia. Euroasian J Hepatogastroenterol. 2017;7(1):55-9.
Hasan I, Gani RA, Sulaiman AS, Lesmana C. Konsensus nasional penatalaksanaan hepatitis C di indonesia. 2017.
Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection. WHO Guidelines Approved by the Guidelines Review Committee. Geneva2018.
Lee SS, Jeong SH, Jang ES, Kim YS, Lee YJ, Jung EU, et al. Prospective cohort study on the outcomes of hepatitis C virus-related cirrhosis in South Korea. J Gastroenterol Hepatol. 2015;30(8):1281-7.
Denniston MM, Jiles RB, Drobeniuc J, Klevens RM, Ward JW, McQuillan GM, et al. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med. 2014;160(5):293-300.
Gigi E, Lagopoulos VI, Bekiari E. Hepatocellular carcinoma occurrence in DAA-treated hepatitis C virus patients: Correlated or incidental? A brief review. World J Hepatol. 2018;10(9):595-602.
Hu J, Liu K, Luo J. HIV-HBV and HIV-HCV Coinfection and Liver Cancer Development. Cancer Treat Res. 2019;177:231-50.
Graham CS, Baden LR, Yu E, Mrus JM, Carnie J, Heeren T, et al. Influence of human immunodeficiency virus infection on the course of hepatitis C virus infection: a meta-analysis. Clin Infect Dis. 2001;33(4):562-9.
Abbas Z, Abbas M. Factors predicting hepatocellular carcinoma in hepatitis C infection. Hepatoma Research. 2018;4.
Brunot A, Le Sourd S, Pracht M, Edeline J. Hepatocellular carcinoma in elderly patients: challenges and solutions. J Hepatocell Carcinoma. 2016;3:9-18.
Ahumada A, Rayón L, Usón C, Bañares R, Alonso Lopez S. Hepatocellular carcinoma risk after viral response in hepatitis C virus-advanced fibrosis: Who to screen and for how long? World J Gastroenterol. 2021;27(40):6737-49.
Leal C, Strogoff-de-Matos J, Theodoro C, Teixeira R, Perez R, Guarana T, et al. Incidence and Risk Factors of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C Treated with Direct-Acting Antivirals. Viruses. 2023;15(1).
Shafira., Muhtadi A. Evaluasi kepatuhan pasien hepatitis C periode Juli 2018 - Juli 2019 di instalasi rawat jalan salah satu rumah sakit Kota Bandung. Farmaka. 2020;18.
Carrat F, Fontaine H, Dorival C, Simony M, Diallo A, Hezode C, et al. Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. Lancet. 2019;393(10179):1453-64.
Abe K, Wakabayashi H, Nakayama H, Suzuki T, Kuroda M, Yoshida N, et al. Factors associated with hepatocellular carcinoma occurrence after HCV eradication in patients without cirrhosis or with compensated cirrhosis. PLoS One. 2020;15(12):e0243473.
Hagiwara H, Ito Y, Ohta T, Nozaki Y, Iwamoto T, Hosui A, et al. Incidence and risk factors of hepatocellular carcinoma in patients with hepatitis C who achieved a sustained virological response through direct-acting antiviral agents among the working population in Japan. JGH Open. 2022;6(6):395-401.
Yang M, Parikh ND, Liu H, Wu E, Rao H, Feng B, et al. Incidence and risk factors of hepatocellular carcinoma in patients with hepatitis C in China and the United States. Sci Rep. 2020;10(1):20922.
Calvaruso V, Cabibbo G, Cacciola I, Petta S, Madonia S, Bellia A, et al. Incidence of Hepatocellular Carcinoma in Patients With HCV-Associated Cirrhosis Treated With Direct-Acting Antiviral Agents. Gastroenterology. 2018;155(2):411-21 e4.
Kurniawan J, Teressa M. Insulin use and the risk of hepatocellular carcinoma: insights and implications. Indones J Intern Med. 2024;56:107 - 13.
Masuzaki R, Tateishi R, Yoshida H, Goto E, Sato T, Ohki T, et al. Prospective risk assessment for hepatocellular carcinoma development in patients with chronic hepatitis C by transient elastography. Hepatology. 2009;49(6):1954-61.
KemenkesRI. Pedoman nasional pelayanan kedokteran tata laksana karsinoma sel hati pada dewasa. In: KemenkesRI, editor. Jakarta: KemenkesRI; 2022.
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).