Risk of Hepatocellular Cancer After Virological Cure with Direct Acting Antiviral Agents in Individuals with Hepatitis C

Abstract

Purpose: The overarching goal of this project is to reduce HCC-related morbidity and mortality in persons with chronic hepatitis C (CHC) who have been virologically cured by direct acting antivirals (DAAs). Aims: 1) Examine determinants of HCC in virologically cured patients and develop a risk prediction model for HCC; 2) Conduct a virtual clinical trial using a mathematical model of the natural history of HCC to evaluate benefits vs harms of HCC surveillance; 3) Develop an online HCC Simulator. Design: Using cause-specific Cox proportional hazard models for competing risks, we will identify risk factors in a retrospective cohort study of >100,000 patients with DAA-induced SVR. For dynamic risk prediction of HCC, we will use the landmark Cox model. We will use a mathematical model to simulate a virtual trial comparing long-term effectiveness of no surveillance vs routine surveillance. Finally, we will develop an interactive decision support tool. Progress: The project is on target to be completed by 09/30/2022.Findings: We identified a range of predictors for HCC in virologically cured patients with CHC. We also found that the nature of predictor variables changed over time. Metabolic traits predicted HCC; however, viral factors (HCV genotype) were no longer predictive at 24 months after cure. A Mathematical model of the natural history of HCC in DAA-cured CHC patients was developed that led the team to conclude that the burden of HCC will shift from viremic to virologically cured CHC patients, and to older populations in the next decade. These findings are reported in a meeting abstract that will be presented during the Liver Meeting 2021 and a manuscript that was accepted by JAMA Network Open.

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Document Details

Document Type
Technical Report
Publication Date
Oct 01, 2021
Accession Number
AD1156248

Entities

People

  • Fasiha Kanwal
  • Jagpreet Chhatwal

Organizations

  • Massachusetts General Hospital

Tags

DTIC Thesaurus Topics

  • Antiviral Agents
  • Covid-19
  • Databases
  • Delivery Of Health Care
  • Demography
  • Genetics
  • Health Services
  • Hepatitis
  • Information Science
  • Liver Diseases
  • Medical Personnel
  • Patient Care
  • Therapy
  • United States
  • Virus Diseases

Fields of Study

  • Medicine

Readers

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