High incidence of hepatocarcinoma in patients with advanced fibrosis treated with direct-acting antiviral agents for hepatitis C: A real-world retrospective study

Background

Patients treated with direct-acting antivirals for hepatitis C exhibit high cure rates and improved survival. However, there is limited knowledge on their long-term clinical evolution.

Aims

In this study, we aimed to analyse the risk of hepatocarcinoma and hepatic decompensation in patients treated with direct-acting antivirals.

Methods

We conducted a retrospective single-centre study of Portuguese patients with advanced fibrosis treated with direct-acting antiviral agents between 2015 and 2022 at a tertiary hospital.

Results

Out of 460 patients, 50 (10.9 %) developed hepatocarcinoma and 36 (7.8 %) experienced hepatic decompensation. The risk for hepatocarcinoma was higher in patients aged over 55 (HR 4.87, 95 % CI 2.34–10.13, p < 0.001), with signs of portal hypertension (HR 3.83, 95 % CI 2.05–7.13, p < 0.001) and arterial hypertension (HR 1.98, 95 % CI 1.09–3.58, p = 0.024). Alcohol consumption (HR 3.30, 95 % CI 1.22–8.94, p = 0.019), signs of portal hypertension (HR 4.56, 95 % CI 2.19–9.48, p < 0.001) and hepatocarcinoma (HR 3.47, 95 % CI 1.69–7.10, p < 0.001) increased the risk of hepatic decompensation.

Conclusion

Our study found a high incidence of hepatocarcinoma and hepatic decompensation, along with high mortality, in patients with advanced fibrosis treated with direct-acting antivirals. We identified risk factors such as arterial hypertension, alcohol consumption, and signs of portal hypertension, highlighting their role in clinical management and patient monitoring.