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Benefits of Hepatitis C Viral Eradication: A Real-World Nationwide Cohort Study in Taiwan
Chin-Wei Chang1, Wei-Fan Hsu1,2,3, Kuo-Chih Tseng4
1Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, 40447, Taichung, Taiwan.
Insights
Eradicating hepatitis C virus (HCV) significantly lowers the risk of liver cancer (HCC) and related events in patients with and without liver cirrhosis. Achieving sustained virologic response (SVR) is key to reducing these risks.
Area of Science:
- Hepatology
- Virology
- Public Health
Background:
- Chronic hepatitis C (CHC) is a significant risk factor for liver cirrhosis (LC) and hepatocellular carcinoma (HCC).
- Assessing the effectiveness of CHC viral eradication is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the impact of hepatitis C virus (HCV) eradication on the incidence of liver-related events, including HCC.
- To compare outcomes between patients who achieved sustained virologic response (SVR) and those who did not.
Main Methods:
- A nationwide cohort study utilizing Taiwanese CHC and HCV registry data linked to the National Health Insurance Research Database.
- Inclusion of 27,577 CHC patients treated with pegylated interferon/ribavirin or direct-acting antiviral agents.
- Analysis of new-onset LC and liver-related events, with a focus on HCC incidence and sustained virologic response (SVR).
Main Results:
- Over 92% of patients (25,461/27,577) achieved SVR.
- Patients without SVR had a significantly higher hazard ratio for incident HCC compared to those with SVR, both in cirrhotic and non-cirrhotic groups.
- SVR was associated with a substantially lower 10-year cumulative incidence of new-onset HCC in both cirrhotic and non-cirrhotic patients.
Conclusions:
- Hepatitis C virus (HCV) eradication effectively reduces the incidence of hepatocellular carcinoma (HCC) in patients with and without liver cirrhosis.
- Viral eradication also lowers the incidence of liver-related events, such as decompensated liver cirrhosis, in patients with existing LC.
- Achieving sustained virologic response (SVR) is critical for mitigating long-term liver disease complications in CHC patients.
Background:
Chronic hepatitis C (CHC) increases the risk of liver cirrhosis (LC) and hepatocellular carcinoma (HCC). This nationwide cohort study assessed the effectiveness of viral eradication of CHC.
Methods:
The Taiwanese chronic hepatitis C cohort and Taiwan hepatitis C virus (HCV) registry are nationwide HCV registry cohorts incorporating data from 23 and 53 hospitals in Taiwan, respectively. This study included 27,577 individuals from these cohorts that were given a diagnosis of CHC and with data linked to the Taiwan National Health Insurance Research Database. Patients received either pegylated interferon and ribavirin or direct-acting antiviral agent therapy for > 4 weeks for new-onset LC and liver-related events.
Results:
Among the 27,577 analyzed patients, 25,461 (92.3%) achieved sustained virologic response (SVR). The mean follow-up duration was 51.2 ± 48.4 months, totaling 118,567 person-years. In the multivariable Cox proportional hazard analysis, the hazard ratio (HR) for incident HCC was 1.39 (95% confidence interval [CI]: 1.00-1.95, p = 0.052) among noncirrhotic patients without SVR compared with those with SVR and 1.82 (95% CI 1.34-2.48) among cirrhotic patients without SVR. The HR for liver-related events, including HCC and decompensated LC, was 1.70 (95% CI 1.30-2.24) among cirrhotic patients without SVR. Patients with SVR had a lower 10-year cumulative incidence of new-onset HCC than those without SVR did (21.7 vs. 38.7% in patients with LC, p < 0.001; 6.0 vs. 18.4% in patients without LC, p < 0.001).
Conclusion:
HCV eradication reduced the incidence of HCC in patients with and without LC and reduced the incidence of liver-related events in patients with LC.
