• Amit G Singal, Nicole E Rich, Neil Mehta, Andrea D Branch, Anjana Pillai, Maarouf Hoteit, Michael Volk, Mobolaji Odewole, Steven Scaglione, Jennifer Guy, Adnan Said, Jordan J Feld, Binu V John, Catherine Frenette, Parvez Mantry, Amol S Rangnekar, Omobonike Oloruntoba, Michael Leise, Janice H Jou, Kalyan Ram Bhamidimarri, Laura Kulik, George N Ioannou, Annsa Huang, Tram Tran, Hrishikesh Samant, Renumathy Dhanasekaran, Andres Duarte-Rojo, Reena Salgia, Sheila Eswaran, Prasun Jalal, Avegail Flores, Sanjaya K Satapathy, Sofia Kagan, Purva Gopal, Robert Wong, Neehar D Parikh, and Caitlin C Murphy.
• Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas. Electronic address: amit.singal@utsouthwestern.edu.
• Gastroenterology. 2019 Nov 1; 157 (5): 1253-1263.e2.

Background & AimsThere is controversy regarding the benefits of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection for patients with a history of hepatocellular carcinoma (HCC). We performed a multicenter cohort study to compare overall survival between patients with HCV infection treated with DAAs and patients who did not receive DAA treatment for their HCV infection after complete response to prior HCC therapy.MethodsWe conducted a retrospective cohort study of patients with HCV-related HCC who achieved a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy, from January 2013 through December 2017 at 31 health care systems throughout the United States and Canada. We used Cox proportional hazards regression to determine the association between receipt of DAA therapy, modeled as a time-varying covariate, and all-cause mortality, accounting for informative censoring and confounding using inverse probability weighting.ResultsOf 797 patients with HCV-related HCC, 383 (48.1%) received DAA therapy and 414 (51.9%) did not receive treatment for their HCV infection after complete response to prior HCC therapy. Among DAA-treated patients, 43 deaths occurred during 941 person-years of follow-up, compared with 103 deaths during 526.6 person-years of follow-up among patients who did not receive DAA therapy (crude rate ratio, 0.23; 95% confidence interval [CI], 0.16-0.33). In inverse probability-weighted analyses, DAA therapy was associated with a significant reduction in risk of death (hazard ratio, 0.54; 95% CI, 0.33-0.90). This association differed by sustained virologic response to DAA therapy; risk of death was reduced in patients with sustained virologic response to DAA therapy (hazard ratio, 0.29; 95% CI, 0.18-0.47), but not in patients without a sustained virologic response (hazard ratio, 1.13; 95% CI, 0.55-2.33).ConclusionsIn an analysis of nearly 800 patients with complete response to HCC treatment, DAA therapy was associated with a significant reduction in risk of death.Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.

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