Hepatocellular carcinoma risk diminishes with time following HCV eradication

Among individuals with cirrhosis and cured hepatitis C virus (HCV) infection, the risk of hepatocellular carcinoma tapers off progressively through 6 years after HCV eradication, as shown in a study. However, the risk remains above thresholds that require screening.

For the study, researchers looked at the medical records of 75,965 HCV-infected Veterans Affairs patients (mean age 64.6 years, 96.0 percent men) who had achieved sustained virologic response (SVR) and remained alive without a diagnosis of HCC. Baseline characteristics were collected, and time accrued since SVR were ascertained. Patients were followed for the subsequent 12 months for HCC incidence.

Multivariable Cox proportional hazards regression showed that among the 19,678 patients with cirrhosis (25.9 percent), those who had accrued >2 to 4 years versus only ≥1 to 2 years since SVR had progressively lower HCC risk (incidence rate, 2.11 vs 2.71 per 100 person-years; adjusted hazard ratio [aHR], 0.80, 95 percent confidence interval [CI], 0.63–1.01).

The same was true for participants who had accrued >4 to 6 years since SVR (incidence rate, 1.65 per 100 person-years; aHR, 0.61, 95 percent CI, 0.41–0.90).

Conversely, the decline in HCC risk appeared to stop at the 6-year mark, as the risk plateaued for patients who had accrued >6 years since SVR (incidence rate, 1.68 per 100 person-years; aHR, 0.70, 95 percent CI, 0.46–1.07).

Among patients without cirrhosis, the incidence of HCC was between 0.23 and 0.27 per 100 person-years. There was no significant association between time since SVR and HCC risk.

The findings underscore the value of time since SVR to inform HCC surveillance strategies in patients with cured HCV infection, with time since SVR having the potential to be incorporated into HCC risk prediction models.