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Antiviral therapy may prevent HCC development in patients with chronic HCV

Patients with chronic hepatitis C treated with interferon or pegylated interferon were less likely to develop hepatocellular carcinoma than patients not receiving antiviral therapy in a recent study.

In a systematic review and meta-analysis, researchers assessed data from eight randomized controlled trials comparing the impact of treatment with antiviral therapy with placebo or no intervention on hepatocellular carcinoma (HCC) development in patients with chronic HCV. Other evaluated factors included overall HCC- and liver-related mortality rates and incidence of liver-related events such as liver failure, spontaneous bacterial peritonitis, variceal bleeding or hepatorenal syndrome.

Two trials assessed patients with either cirrhosis or fibrosis; the others only evaluated cirrhotic patients. Participants received interferon monotherapy in five studies, pegylated interferon in two studies and interferon with ribavirin in one. Treatment duration ranged from 1 to 5 years; follow-up was from 2 to 8.7 years.

Antiviral therapy was associated with a reduced risk for HCC (RR=0.53; 95% CI, 0.34-0.81), with a number needed to treat of eight patients. Investigators noted that patients who responded to treatment benefited more from antiviral therapy than nonresponders (RR=0.15; 95% CI, 0.05-0.45 vs. RR=0.57; 95% CI, 0.37-0.85). Reduction in HCC risk remained after excluding trials involving patients with fibrosis (RR=0.51; 95% CI, 0.34-0.77) and those without adequate randomization (RR=0.58; 95% CI, 0.37-0.95). No evidence of bias (P=.931) for the included controlled trials was detected.

Among trials reporting mortality rates, antiviral treatment did not have a significant impact on all-cause (RR=0.81; 95% CI, 0.33-2.03) or liver-related mortality (RR=0.71; 95% CI, 0.2-2.51), or on incidence of liver-related morbidity (RR=0.73; 95% CI, 0.48-1.11).

“This review found that antiviral therapy may prevent HCC in patients with hepatitis C-related fibrosis or cirrhosis,” the researchers wrote. “[However,] based on the duration of follow-up and the lack of clear evidence concerning morbidity or mortality, we cannot exclude that interferon delays rather than prevents carcinogenesis. Additional randomized trials with longer follow-up are still warranted to determine whether this is the case.”