Hepatocellular Carcinoma Risk Declines but Remains High Enough for Screening in the First 7 Years After Hepatitis C Virus Cure With Direct-Acting Antivirals in Patients With Cirrhosis or High Fibrosis-4 Score

Abstract

Hepatitis C virus (HCV) eradication by direct-acting antiviral (DAA) medications has been found to reduce hepatocellular carcinoma (HCC) risk, but a substantial risk persists in patients with cirrhosis and those with Fibrosis-4 (FIB-4) score ≥3.25. 1 Ioannou G.N. et al. Gastroenterology. 2019; 157: 1264-1278.e4 Abstract Full Text Full Text PDF PubMed Scopus (152) Google Scholar ,2 Ioannou G.N. et al. J Hepatol. 2018; 68: 25-32 Abstract Full Text Full Text PDF Scopus (258) Google Scholar In a previous study, we found that, during the first 4 years after DAA-induced sustained virologic response (SVR), annual HCC incidence remained well above 2% in those with pretreatment cirrhosis and above 1% in those without cirrhosis but with pretreatment FIB-4 score ≥3.25. 1 Ioannou G.N. et al. Gastroenterology. 2019; 157: 1264-1278.e4 Abstract Full Text Full Text PDF PubMed Scopus (152) Google Scholar In that study, annual HCC risk declined during the first 4 years of follow-up, but the follow-up time was not long enough to determine whether HCC risk continues to decline to levels low enough that HCC screening may no longer be warranted. In this study, we extended the follow-up of this DAA-cured cohort up to 7 years to determine whether annual HCC risk, stratified by cirrhosis and FIB-4 categories, declines to levels low enough to preclude the requirement for HCC screening.