Cirrhotic Patients with HCV Retain Liver Event Risk Despite Treatment Response

Justin P. Canakis, DO

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A new study provided insight into the long-term response of liver-related and non-liver-related disease among patients with hepatitis C virus (HCV)-related cirrhosis following sustained virologic response after direct-acting agent therapy.

A sustained virologic response with direct-acting antivirals can lead to improvements in liver-related events and non-liver-related events. Most available literature has analyzed the long-term outcomes of patients treated with interferon-based therapy, but not the outcomes of patients with HCV-related cirrhosis.

The study, presented at The Liver Meeting 2023 from the American Association for the Study of Liver Diseases (AASLD), showed patients with HCV-related cirrhosis remained at substantial risk for liver-related and non-liver-related events even after achieving sustained therapy response.

“Patients with HCV-related cirrhosis remain at substantial risk for developing liver-related and non-liver-related events after achieving sustained virologic response with directly acting agent therapy,” wrote the investigative team, led by Justin P. Canakis, DO, department of medicine, George Washington University School of Medicine and Health Sciences.

Canakis and colleagues noted there is little data identifying the long-term outcomes of patients with advanced fibrosis and cirrhosis after being treated with HCV directly acting agents. For this analysis, the investigative team aimed to assess the long-term outcomes of liver-related disease and non-liver-related disease in patients with HCV-related cirrhosis following sustained virologic response after direct-acting agent therapy.

The investigative team performed a retrospective, observational cohort study of 248 patients who were treated for Hepatitis C from 2008 to 2021.All included patients had confirmed HCV by PCR tests and were treated with directly acting agents for 8, 12, or 24 weeks or as clinically indicated. Other inclusion criteria consisted of either confirmed cirrhosis on liver biopsy or stage F4 on transient elastography and platelet count <150 to isolate fibroscans that were considered artificially elevated.

Canakis and team performed a retrospective chart review of all cirrhotic patients successfully treated with directly acting agents and assessed if the patient was diagnosed with HCC, esophageal varices, non-Hodgkin’s lymphoma, diabetes, myocardial infarction, or thyroid disease after treatment. Investigators also assessed the performance of esophagogastroduodenoscopies (EGDs) and radiographic screenings for HCC to assess the incidence of variceal monitoring and HCC screening.

A total of 59 patients (24%) had cirrhosis diagnosed by liver biopsy or transient elastography. Of this population, 36 patients (61%) were men, the average age was 59.5 years, and the average duration of HCV infection was 30 years (range, 6 to 50 years).

Upon analysis, investigators found that 62.7% (n = 37) of patients never had an EGD, 22% (n = 13) had 1 EGD, and 15% (n = 9) had ≥2 EGDs. The study detected esophageal varices in 32% (n = 7) of patients who were screened. Moreover, in terms of HCC with abdominal ultrasounds, data showed 37.3% (n =22) of patients had no ultrasound performed, 28.8% (n = 17) had 1 ultrasound, and 34% (n = 20) had >2 ultrasounds. Analyses also showed 15.3% of patients had an MRI performed and 18.7% had a CT scan for HCC screening.

In analyzing long-term health outcomes, investigators found 4 (6.8%) patients were diagnosed with HCC, no patients were diagnosed with non-Hodgkin’s lymphoma, 10 patients developed diabetes, 2 patients had a myocardial infarction, and 2 developed thyroid disease. Overall, the team indicated patients with HCV-related cirrhosis remain at substantial risk for developing liver-related and non-liver-related events, despite low rates of surveillance for some outcomes.

“However, our cohort revealed suboptimal rates of surveillance for HCC and esophageal varices,” Canakis and colleagues wrote.

References

_{Canakis JP, Schalet R, Siegel M. Long-term Outcomes of Cirrhotic Patients with Chronic Hepatitis C Virus after Achieving Sustained Virologic Response.}