Direct-Acting Antiviral Therapy in Patients With Hepatocellular Carcinoma Receiving Non-Curative Treatment: High Sustained Virological Response Rates and Preservation of Liver Functional Reserve.
In a retrospective single-center cohort of predominantly adult patients with chronic HCV, DAA therapy produced high SVR12 rates across HCC-history groups and was associated with preserved, but not improved, liver functional reserve after non-curative HCC treatment.
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In a retrospective single-center cohort of predominantly adult patients with chronic HCV, DAA therapy produced high SVR12 rates across HCC-history groups and was associated with preserved, but not improved, liver functional reserve after non-curative HCC treatment.
Research significance
Evidence: DAA therapy achieved a 96.1% overall SVR12 rate, with similarly high responses after non-curative HCC treatment, while measured liver functional reserve remained stable and did not differ by early versus delayed initiation. Inference: HCV eradication could serve as a supportive strategy to preserve hepatic treatment capacity in selected patients receiving non-curative HCC therapy, but causal benefit, safety, survival impact, and pediatric applicability are not established.
Source abstract
Direct-acting antivirals (DAAs) cure most chronic hepatitis C virus (HCV) infections, but their impact on liver functional reserve in patients with a history of hepatocellular carcinoma (HCC), particularly after non-curative HCC treatment, remains unclear. We evaluated antiviral efficacy and liver functional reserve after DAA therapy according to HCC history and timing of DAA initiation. In this retrospective single-center cohort, 716 patients initiated DAA therapy, and 690 with evaluable sustained virological response at 12 weeks after treatment (SVR12) were analysed. Patients were classified as no HCC, curative-treated HCC, or non-curative-treated HCC according to the most recent HCC treatment before DAA initiation. Liver functional reserve was assessed using the albumin-bilirubin (ALBI) score, modified ALBI grade, and Child-Pugh class. In the non-curative-treated HCC group, early (≤ 3 months) versus delayed (> 3 months) DAA initiation after the most recent HCC treatment was compared. Overall SVR12 was 96.1%, with similarly high rates across groups regardless of HCC history. The median ALBI score improved from -2.35 to -2.58 at SVR12 in the curative-treated HCC group (p < 0.001) but remained unchanged in the non-curative-treated HCC group (-2.36 to -2.38). Among 64 patients with a history of HCC, 43 (67.2%) developed recurrence; in these patients, the ALBI score improved from -2.31 at DAA initiation to -2.57 at recurrence (p < 0.001), and more than 90% remained Child-Pugh class A. Early and delayed DAA initiation showed similarly high SVR12 rates and comparable liver functional reserve. DAAs achieved high SVR12 rates and maintained liver functional reserve in patients with HCV, including those with a history of HCC after non-curative treatment.