HCV Treatment Improve Outcomes in Patients with Hepatocellular Carcinoma

Subhash Garikipati, MD

A new study investigated the role of direct-acting antiviral (DAA) agents and variables affecting outcomes in patients who were diagnosed with both chronic hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC).

Investigators, led by Subhash Garikipati, MD, Department of Internal Medicine, Louisiana State University, found that treating HCV improved outcomes in HCC for patients.

The team used a retrospective analysis of all patients diagnosed with HCV and HCC between 2012 – 2019 at a tertiary care hospital in Louisiana.

Study

They performed univariate linear correlation and regression tests to assess significant variables affecting mortality.

A total of 240 patients were included in the analysis. Investigators found patients treated for HCV infection had significantly improved mortality.

There was a significant association found between smoking, poor performance at baseline, lack of insurance coverage and increased overall mortality.

Of the total, 192 (80%) of patients were reported in the variable section of smoking, with 141 (59%) patients scoring a 1 on the ECOG scale (0 – 4), all P <.01.

A total of 63 (26%) patients had no insurance reported, P <.01

Patients with larger and multiple nodules at the time of diagnosis were found to have increased overall mortality.

Data show 96 (43%) of patients had a single nodule at diagnosis, while 126 (57%) had multiple nodules, all P <.01. The average nodule size was 5.0 cm, P = .01.

Investigators also found lower BMI, male gender, and older age were associated with higher overall mortality.

Data show a BMI ≥30 kg/m2 was found on 37 (15%) of patients while 203 (85%) had a BMI <30 kg/m2.

Of the total, 188 (78%) patients were male and 209 (87%) of patients were ≥55 years old.

Investigators noted that aspirin use was associated with a decreased overall mortality, with 65 (27%) of patients using aspirin and 175 (73%) not using aspirin, P = .04.

The team found no significant correlation between gallstone presence, vitamin E use, statin use, or race with overall mortality.

Discussion

Garikipati and colleagues found treating HCV was indicative of improved outcomes in patients with HCC.

They noted that previous studies found patients with higher BMI also had increased mortality rates in HCC.

However, the team found patients with lower BMI had increased mortality, which they likened to patients being diagnosed at later stages with malignancy induced cachexia.

Patients without insurance had higher mortality rates, which investigators attributed to the larger expesnes of HCV treatment, including frequent clinic visits and the cost of the DAAs.

The team noted that in 2019, Louisiana made generic sofosbuvir and velpatasvir available at low cost.

“The impact of the introduction of generic DAAs on overall outcomes in patients with both HCV and HCC is currently underway at our institution,” investigators wrote.

The study, “Variables Influencing Mortality in Chronic Hepatitis C Patients with Hepatocellular Carcinoma: A Single Center Experience, was published online by the 2021 Digestive Disease Week Virtual Meeting.