P-148 - High rates of hepatocellular carcinoma within two years of starting treatment for chronic hepatitis C with direct antiviral agents but not with PEG-interferon/ Ribavirin (HORRID Study)

Abstract

Introduction: Direct acting antivirals (DAA) have revolutionized the treatment of chronic hepatitis C (CHC). DAAs have replaced previous therapy regimes based on PEG-interferon (PEG-IFN) and Ribavirin (RBV). An increased risk for hepatocellular carcinoma (HCC) in patients with advanced liver disease and CHC is known. Effects of DAA-based hepatitis C treatment on subsequent HCC incidence are insufficiently understood. Methods: This retrospective single-institution analysis included 220 consecutive patients after PEG-IFN/RBV and 259 patients after DAA treatment for CHC. HCC, viral load, genotype, treatment type, duration and outcome, fibrosis stage, age, gender, BMI and serum albumin were retrieved. A Cox-proportional hazard model was fit to predict survival regarding HCC, need for liver transplantation, and death. Patient blood samples were retrieved prior, during, and after therapy to compare neutrophil-to-lymphocyte ratio. Results: There were 8 HCC cases among patients treated with DAA observed compared with 17 cases after PEG-INF/RBV treatment. In a multivariate Cox-proportional hazard model, DAA treatment (HR 5.5; P = .047), age (HR 1.07/year; P = .004) and SVR (HR 0.23; P = .002) were significant predictors for HCC. After DAA treatment, time to HCC diagnosis was significantly shorter compared with after PEG-INF/RBV (0.84 years, range: 0.5-2.1 vs. 6.8 years, range: 2.3-15). HCC occurrence was highest within the first year after the start of DAA treatment (5 cases) but lower thereafter (3 cases). Death and the need for liver transplantation did not differ between both groups. Neutrophil-to-lymphocyte ratio results will be ready for the poster presentation. Conclusion: Our data show higher rates of HCC immediately after DAA compared with after PEG-IFN/RBV treatment. A high degree of suspicion regarding HCC seems warranted especially within the first year after the start of DAA treatment.