Past history of hepatocellular carcinoma is an independent risk factor of treatment failure in patients with chronic hepatitis C virus infection receiving direct‐acting antivirals

Abstract

Summary Direct‐acting antiviral ( DAA ) treatment can achieve a high sustained virological response ( SVR ) rate in patients with hepatitis C virus ( HCV ) infection regardless of a history of hepatocellular carcinoma ( HCC [+]). We examined 838 patients (370 men, median age: 69 years) who were treated with DAA s for comparisons of clinical findings between 79 HCC (+) (9.4%) and 759 HCC (−) (90.6%) patients and associations with treatment outcome. Male frequency was significantly higher in the HCC (+) group (60.8% vs 42.4%, P = 0.006). There were significant differences between the HCC (+) and HCC (−) groups for platelet count (115 vs 152 ×10 9 /L, P < 0.001), baseline alpha fetoprotein ( AFP ) (9.9 vs 4.5 ng/mL, P < 0.001) and the established fibrosis markers of FIB ‐4 index (4.7 vs 3.0, P < 0.001), AST‐to‐platelet ratio index ( APRI ) (1.1 vs 0.7, P = 0.009), M2 BPG i (3.80 vs 1.78 COI , P < 0.001) and autotaxin (1.91 vs 1.50 mg/L, P < 0.001). The overall SVR rate was 94.7% and significantly lower in the HCC (+) group (87.3 vs 95.5%, P = 0.001). Multivariate analysis revealed that a history of HCC was independently associated with DAA treatment failure (odds ratio: 3.56, 95% confidence interval: 1.32‐9.57, P = 0.01). In conclusion, patients with chronic HCV infection and prior HCC tended to exhibit more advanced disease progression at DAA commencement. HCC (+) status at the initiation of DAA s was significantly associated with adverse therapeutic outcomes. DAA treatment for HCV should therefore be started as early as possible, especially before complicating HCC .