August 20, 2018
Patients with chronic hepatitis C virus (HCV) infection who have a history of hepatocellular carcinoma (HCC) face a higher risk of direct-antiviral agent (DAA) treatment failure, according to a new study published online in the Journal of Viral Hepatitis.
For their study, the researchers evaluated 838 DAA-treated patients with HCV. Of these patients, 79 had a history of HCC, while 759 did not.
Notably, there was a significantly higher proportion of men in the HCC-positive group compared with the HCC-negative group (60.8% vs 42.4%).
Significant between-group differences were also observed for:
- Platelet count (115 vs 152 x109/L)
- Baseline alpha-fetoprotein (9.9 vs 4.5 ng/ml)
- Established fibrosis markers of the Fibrosis‐4 index (4.7 vs 3.0)
- Aspartate aminotransferase to platelet ratio index (1.1 vs 0.7)
- Mac-2 binding protein glycan isomer levels (3.80 vs 1.78 COI)
- Autotaxin levels (1.91 vs 1.50 mg/L)
In this cohort, the overall rate of sustained virologic response (SVR) was 94.7%. Results indicated that the rate of SVR was significantly lower in patients with history of HCC compared with those without history of HCC (87.3% vs 95.5%).
Findings from a multivariate analysis demonstrated an independent association between history of HCC and DAA treatment failure, with an odds ratio of 3.56.
“In conclusion, patients with chronic HCV infection and prior HCC tended to exhibit more advanced disease progression at DAA commencement,” the researchers wrote. “[HCC-positive] status at the initiation of DAAs was significantly associated with adverse therapeutic outcomes. DAA treatment for HCV should therefore be started as early as possible, especially before complicating HCC.”
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