Clinical Gastroenterology and Hepatology
Volume 8, Issue 2 , Pages 192-199, February 2010

Antiviral Therapy Reduces Risk of Hepatocellular Carcinoma in Patients With Hepatitis C Virus–Related Cirrhosis

  • Ashwani K. Singal

      Affiliations

    • Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas
    • Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    • ,
  • Amanpal Singh

      Affiliations

    • Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas
    • Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    • ,
  • Sathya Jaganmohan

      Affiliations

    • Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas
    • Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    • ,
  • Praveen Guturu

      Affiliations

    • Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    • ,
  • Rajasekhara Mummadi

      Affiliations

    • Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas
    • Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    • ,
  • Yong–Fang Kuo

      Affiliations

    • Sealy Center of Aging, University of Texas Medical Branch, Galveston, Texas
    • ,
  • Gagan K. Sood

      Affiliations

    • Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas
    • Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    • Corresponding Author InformationReprint requests Address requests for reprints to: Gagan K. Sood, MD, Baylor College of Medicine, 1709 Dryden, Suite 1500, Houston, Texas 77030. fax: (713) 798-0951

published online 02 November 2009.

Background & Aims

The effects of antiviral therapy on prevention of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV)-related cirrhosis are unclear. We performed a systematic review and meta-analysis to assess HCC risk reduction in patients with HCV-related cirrhosis who have received antiviral therapy.

Methods

Twenty studies (4700 patients) were analyzed that compared untreated patients with those given interferon (IFN) alone or ribavirin. Risk ratios (RRs) determined effect size using a random effects model.

Results

Pooled data showed reduced HCC risk in the treatment group (RR, 0.43; 95% confidence interval [CI], 0.33–0.56), although the data were heterogenous (χ2 = 59.10). Meta-regression analysis showed that studies with follow-up durations of more than 5 years contributed to heterogeneity. Analysis of 14 studies (n = 3310) reporting sustained virologic response (SVR) rates with antiviral treatment showed reduced HCC risk in patients with an SVR, compared with nonresponders (RR, 0.35; 95% CI, 0.26–0.46); the maximum benefits were observed in patients treated with ribavirin-based regimens (RR, 0.25; 95% CI, 0.14–0.46). Meta-analysis of 4 studies assessing the role of maintenance IFN in nonresponders did not show HCC risk reduction (RR, 0.58; 95% CI, 0.33–1.03). No publication bias was detected by the Egger test analysis (P > 0.1).

Conclusions

The risk of HCC is reduced among patients with HCV who achieve an SVR with antiviral therapy. Maintenance therapy with IFN does not reduce HCC risk among patients who do not respond to initial therapy.

View this article's video abstract at www.cghjournal.org.

Abbreviations used in this paper: CI, confidence interval, HCC, hepatocellular carcinoma, HCV, hepatitis C virus, MU, million units, PEG-IFN, pegylated interferon, RBV, ribavirin, RCT, randomized controlled trial, RR, risk ratio, SVR, sustained virologic response

 

 This article has an accompanying continuing medical education activity on page e21. Learning Objectives—At the end of this activity, the learner should explain the risk for developing hepatocellular carcinoma in chronic hepatitis C, and identify the outcome of antiviral therapy that is most important in reducing the risk.

 Conflicts of interest The authors disclose no conflicts.

PII: S1542-3565(09)01085-4

doi:10.1016/j.cgh.2009.10.026

Clinical Gastroenterology and Hepatology
Volume 8, Issue 2 , Pages 192-199, February 2010