Abstract
universal sustained virological response (SVR), it is eagerly hoped that morbidity and mortality from hepatitis C virus (HCV) will soon disappear. At present, cirrhosis, the predominant risk factor for hepatocellular carcinoma (HCC), is increasing among patients with HCV as they become older and the duration of infection longer. We estimate the impact of DAAs with high SVR rates on the incidence of HCC in the population. Methods: Since the extent to which the risk of HCC decreases in patients with established cirrhosis achieving SVR remains poorly defined, we conducted a simulation experiment in which a cohort of 50 year-old subjects (n = 1,000) with compensated HCV cirrhosis (MELD=6) is followed for 20 years. In a viremic subject, the MELD score, HCC and mortality from end stage liver disease (ESLD) would increase progressively. Once SVR is achieved, MELD would stop increasing and the proportion at risk of HCC decrease over time. Results: The Table summarizes 20-year outcomes in the 50 year-old cohort based on SVR eliminating HCC risk in 3%/year.
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