Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis
Recent studies have suggested a negative impact of hepatocellular carcinoma (HCC) on sustained virologic response (SVR) to hepatitis C virus (HCV) direct acting antivirals (DAAs). We compared the effectiveness of DAAs in patients with cirrhosis, with and without HCC, and in those with HCC partially...
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doaj-4e9e0104dcf848c6a5db6f6caa6f34fe2020-11-24T22:07:23ZengWileyHepatology Communications2471-254X2019-10-013101388139910.1002/hep4.1412Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET AnalysisKavita Radhakrishnan0Adrian M. Di Bisceglie1K. Rajender Reddy2Joseph K. Lim3Josh Levitsky4Mohamed A. Hassan5Jama M. Darling6Jordan J. Feld7Lucy Akushevich8Monika Vainorius9David R. Nelson10Michael W. Fried11Robert S. Brown Jr.12Norah A. Terrault13University of California, San Francisco San Francisco CASt. Louis University School of Medicine St. Louis MOUniversity of Pennsylvania Philadelphia PAYale University School of Medicine New Haven CTNorthwestern University Evanston ILUniversity of Minnesota Minneapolis MNUniversity of North Carolina at Chapel Hill Chapel Hill NCToronto Western Hospital Liver Center Toronto CanadaUniversity of North Carolina at Chapel Hill Chapel Hill NCUniversity of North Carolina at Chapel Hill Chapel Hill NCUniversity of Florida Gainesville FLUniversity of North Carolina at Chapel Hill Chapel Hill NCWeill Cornell Medical College New York NYKeck School of Medicine of the University of Southern California Los Angeles CARecent studies have suggested a negative impact of hepatocellular carcinoma (HCC) on sustained virologic response (SVR) to hepatitis C virus (HCV) direct acting antivirals (DAAs). We compared the effectiveness of DAAs in patients with cirrhosis, with and without HCC, and in those with HCC partially treated or untreated (PT/UT‐HCC) versus completely treated (CT‐HCC). HCC status was based on imaging 6 months before or 2 months after start of DAA therapy. Absence and presence of enhancing lesions after HCC treatment defined CT‐HCC and PT/UT‐HCC, respectively. Using minimally adjusted logistic regression, the association between the presence of HCC and SVR rates was estimated. Among the 1,457 patients with cirrhosis from HCV‐TARGET with complete virologic data (per‐protocol population) who did not undergo liver transplantation during treatment and followup, 1,300 were without HCC, 91 with CT‐HCC, and 66 with PT/UT‐HCC. Most patients were genotype 1 (81%) and treatment‐experienced (56%), 41% had history of prior decompensation, and the median pretreatment Model for End‐Stage Liver Disease was 9 (range 6‐39). The SVR rates were 91% for patients without HCC, 84% for CT‐HCC, and 80% for PT/UT‐HCC. The presence of HCC (versus not having HCC) was associated with significantly lower odds of achieving SVR (odds ratio [OR] = 0.51, 95% confidence interval [CI]: 0.33‐0.81; P = 0.003). However, among those with HCC, HCC treatment status (PT/UT‐HCC versus CT‐HCC) did not show association with SVR (OR = 0.79, 95% CI: 0.35‐1.79, P = 0.569). Conclusions: The presence of HCC reduces the likelihood of SVR by 50%, but with no evident difference in those with completely treated HCC versus partially treated/untreated HCC.https://doi.org/10.1002/hep4.1412 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kavita Radhakrishnan Adrian M. Di Bisceglie K. Rajender Reddy Joseph K. Lim Josh Levitsky Mohamed A. Hassan Jama M. Darling Jordan J. Feld Lucy Akushevich Monika Vainorius David R. Nelson Michael W. Fried Robert S. Brown Jr. Norah A. Terrault |
spellingShingle |
Kavita Radhakrishnan Adrian M. Di Bisceglie K. Rajender Reddy Joseph K. Lim Josh Levitsky Mohamed A. Hassan Jama M. Darling Jordan J. Feld Lucy Akushevich Monika Vainorius David R. Nelson Michael W. Fried Robert S. Brown Jr. Norah A. Terrault Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis Hepatology Communications |
author_facet |
Kavita Radhakrishnan Adrian M. Di Bisceglie K. Rajender Reddy Joseph K. Lim Josh Levitsky Mohamed A. Hassan Jama M. Darling Jordan J. Feld Lucy Akushevich Monika Vainorius David R. Nelson Michael W. Fried Robert S. Brown Jr. Norah A. Terrault |
author_sort |
Kavita Radhakrishnan |
title |
Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis |
title_short |
Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis |
title_full |
Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis |
title_fullStr |
Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis |
title_full_unstemmed |
Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis |
title_sort |
treatment status of hepatocellular carcinoma does not influence rates of sustained virologic response: an hcv‐target analysis |
publisher |
Wiley |
series |
Hepatology Communications |
issn |
2471-254X |
publishDate |
2019-10-01 |
description |
Recent studies have suggested a negative impact of hepatocellular carcinoma (HCC) on sustained virologic response (SVR) to hepatitis C virus (HCV) direct acting antivirals (DAAs). We compared the effectiveness of DAAs in patients with cirrhosis, with and without HCC, and in those with HCC partially treated or untreated (PT/UT‐HCC) versus completely treated (CT‐HCC). HCC status was based on imaging 6 months before or 2 months after start of DAA therapy. Absence and presence of enhancing lesions after HCC treatment defined CT‐HCC and PT/UT‐HCC, respectively. Using minimally adjusted logistic regression, the association between the presence of HCC and SVR rates was estimated. Among the 1,457 patients with cirrhosis from HCV‐TARGET with complete virologic data (per‐protocol population) who did not undergo liver transplantation during treatment and followup, 1,300 were without HCC, 91 with CT‐HCC, and 66 with PT/UT‐HCC. Most patients were genotype 1 (81%) and treatment‐experienced (56%), 41% had history of prior decompensation, and the median pretreatment Model for End‐Stage Liver Disease was 9 (range 6‐39). The SVR rates were 91% for patients without HCC, 84% for CT‐HCC, and 80% for PT/UT‐HCC. The presence of HCC (versus not having HCC) was associated with significantly lower odds of achieving SVR (odds ratio [OR] = 0.51, 95% confidence interval [CI]: 0.33‐0.81; P = 0.003). However, among those with HCC, HCC treatment status (PT/UT‐HCC versus CT‐HCC) did not show association with SVR (OR = 0.79, 95% CI: 0.35‐1.79, P = 0.569). Conclusions: The presence of HCC reduces the likelihood of SVR by 50%, but with no evident difference in those with completely treated HCC versus partially treated/untreated HCC. |
url |
https://doi.org/10.1002/hep4.1412 |
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