Risk of Hepatocellular Cancer after Virological Cure with Direct Acting Antiviral Agents in Individuals with Hepatitis C
Abstract
We identified a range of predictors for HCC in virologically cured patients with CHC. Risk factors for HCC were different in patients with and without cirrhosis and some also evolved during follow-up. These factors can help with risk stratification and HCC surveillance decisions in patients with cured HCV. The AUCs for the models in patients with and without cirrhosis were 0.72 (95 percent CI, 0.70-0.74) and 0.68 (95 percent CI, 0.66-0.70), respectively. We developed a mathematical model of the natural history of HCC in DAA-cured CHC patients. We found that the burden of HCC will shift from viremic to virologically cured CHC patients, and to older populations in the next decade. In a separate analysis, we found that biannual surveillance for HCC in virologically-cured hepatitis C patients with cirrhosis is cost-effective until the age of 6. Our results also showed that routine surveillance is warranted above the HCC incidence threshold of 0.7 per 100-PY, which is lower than the previous 1.5 percent incidence value used to guide HCC surveillance decisions (manuscript published in Clinical Gastroenterology and Hepatology). Updating clinical guidelines could improve the early diagnosis of HCC. We also developed an online Liver Cancer Simulator to improve patient decision-making and engagement in HCC surveillance. Feedback from providers indicated that the Simulator was acceptable and feasible and that it has a high likelihood of being implemented in their clinical settings.
Document Details
- Document Type
- Technical Report
- Publication Date
- Dec 01, 2023
- Accession Number
- AD1227011
Entities
People
- Fasiha Kanwal
- Jagpreet Chhatwal
Organizations
- Baylor College of Medicine