Abstract
Background: Hepatocellular carcinoma (HCC) rarely develops in patients with chronic hepatitis C (CHC) who achieve sustained virological response (SVR). We assessed the incidence of HCC in CHC patients with hemophilia after treatment with pegylated interferon plus ribavirin (PegIFN/RBV) and direct-acting antivirals (DAAs). Methods: Patients (n = 202) were enrolled between March 2007 and July 2019. A total of 139 patients were treated with PegIFN/RBV (genotype 1, n = 98; genotype 2, n = 41). Sixty-three patients were treated with DAAs (genotype 1, n = 44; genotype 2, n = 19). The cumulative incidence rates of HCC were estimated using the Kaplan–Meier method and compared using the log-rank test. Results: For genotype 1, SVR was achieved in 78.6% (77/98) and 90.9% (40/44) of patients in the PegIFN/RBV and DAAs groups, respectively. For genotype 2, SVR was achieved in 95.1% (39/41) and 94.7% (18/19) of patients in the PegIFN/RBV and DAAs groups, respectively. Six HCC cases were identified. The cumulative incidence of HCC was 4.1% at 14 years in PegIFN/RBV and 1.7% at 5 years in DAAs. The 14-year cumulative incidence of HCC was 1.9% in the SVR group and 21.7% in the no-SVR group in the PegIFN/RBV group (p < 0.001). Conclusions: Treatment with PegIFN/RBV led to stable SVR and a low incidence of HCC. Although the follow-up period was short, DAAs led to more stable SVR than PegIFN/RBV and a low incidence of HCC in CHC patients with hemophilia.
Highlights
Hepatitis C virus (HCV) infection causes chronic hepatitis C (CHC), which is the leading cause of liver cirrhosis (LC) and hepatocellular carcinoma (HCC) [1,2]
Interferon therapy has been used for treating HCV since the 1980s
Clinical characteristics of patients with newly developed hepatocellular carcinoma after antiviral results indicate that the sustained virological response (SVR) rates of the PegIFN/RBV and direct-acting antivirals (DAAs) groups were similar to the SVR of2 CHC patients without hemophilia
Summary
Hepatitis C virus (HCV) infection causes chronic hepatitis C (CHC), which is the leading cause of liver cirrhosis (LC) and hepatocellular carcinoma (HCC) [1,2]. Since 2011, direct-acting antivirals (DAAs) have enabled advances greatly in the treatment of HCV through high-sustained virological response (SVR). In the early 1990s, most patients with hemophilia were treated with contaminated blood-derived clotting factor products. They were infected with HCV, and 80% of them had CHC [10,11]. Hepatocellular carcinoma (HCC) rarely develops in patients with chronic hepatitis C (CHC) who achieve sustained virological response (SVR). We assessed the incidence of HCC in CHC patients with hemophilia after treatment with pegylated interferon plus ribavirin (PegIFN/RBV) and direct-acting antivirals (DAAs). Results: For genotype 1, SVR was achieved in 78.6% (77/98)
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