Risk of Hepatocellular Cancer After Virological Cure with Direct Acting Antiviral Agents in Individuals with Hepatitis C
Abstract
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 identified risk factors in a retrospective cohort study of greater than 100,000 patients with DAA-induced SVR. For dynamic risk prediction of HCC, we used the landmark Cox model. We used a mathematical model to simulate a virtual trial comparing long-term effectiveness of no surveillance vs routine surveillance. Finally, we developed an interactive decision support tool. Progress: The project has been completed. Findings: 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 inpatients with cured HCV. These findings were reported in a manuscript published in the Am J Gastroenterology. The AUCs for the models inpatients 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. These findings are reported in a manuscript published in the JAMA Network Open.
Document Details
- Document Type
- Technical Report
- Publication Date
- Dec 01, 2023
- Accession Number
- AD1227012
Entities
People
- Fasiha Kanwal
- Jagpreet Chhatwal
Organizations
- Massachusetts General Hospital