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HBV-related HCC declines as HCV-related HCC increases in Australia

A data linkage study from New South Wales, Australia showed hepatitis B-associated hepatocellular carcinoma rates declined in recent years, whereas hepatitis C-associated HCC rates increased.

Reem Waziry, MD, PhD candidate, of The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Australia, and colleagues, including Gregory J. Dore, MD, head of the Viral Hepatitis Clinical Research Program at The Kirby Institute at University New South Wales, linked data on HBV and HCV notifications to the NSW Admitted Patients Data Collection database and the NSW Registry of Births, Deaths and Marriages to calculate infection burden and crude and age-standardized HCC incidence based on a patient’s first hospitalization.

Gregory J. Dore

“The mandatory notification of HBV and HCV diagnoses in Australia and well-established surveillance systems provide the opportunity to evaluate HCC burden at the individual and population levels, including temporal trends and factors associated with HCC,” the researchers wrote.

Between 2000 and 2014, individuals with HBV (n = 54,399), HCV (n = 93,099) and HBV/HCV coinfection (n = 3,809) in New South Wales were notified. Of these, 725 with HBV notification also had HCC compared with 1,309 individuals with HCV notification also having HCC.

The population-level burden of new HCC cases per year stabilized and decreased in the HBV cohort from 2001 to 2013 (53 vs. 44). However, the number of new HCC cases more than tripled in the HCV cohort across the same time period (49 in 2001 vs. 151 in 2013).

In the HBV cohort, the age-standardized incidence rates of HCC per 1,000 person-years decreased from 2.3 (95% CI, 1.4-3.1) in 2001 to 0.9 (95% CI, 0.6-1.2) in 2012. This incidence rate remained stable between 2001 (1.4; 95% CI, 0.8-1.9) and 2012 (1.5; 95% CI, 1.2-1.7) in the HCV cohort.

Adjusted Cox proportional hazards analyses showed between 2005 and 2009, and between 2010 and 2014, male gender (HR = 4.50; 95% CI, 3.6-5.6), Asia-Pacific country of birth (HR = 3.84; 95% CI, 2.58-5.71) and alcohol dependency (HR = 2.84; 95% CI, 1.95-4.13) were the main factors associated with HCC in those with HBV. The main factors associated with HCC in those with HCV included male gender (HR = 2.56; 95% CI, 2.20-2.98), rural place of residence (HR = 0.73; 95% CI, 0.62-0.86), Asia-Pacific country of birth (HR = 2.37; 95% CI, 1.99-2.82) and alcohol dependency (HR = 3.90; 95% CI, 3.39-4.49).

The researchers suggested the decline in HBV-related HCC was due to the positive impact of more effective antiviral therapy developed in the mid-2000s.

“In contrast, the interferon-containing HCV treatment era had no impact on individual-level HCV-related HCC risk and has seen escalating population-level HCC burden,” the researchers wrote.

To help monitor and management viral hepatitis, the researchers wrote that their surveillance system could be useful for future strategy development.

“The surveillance system we have developed, particularly with the addition of individual-level HBV and HCV treatment data will be a valuable tool for evaluation of enhanced strategies for viral hepatitis diagnosis and treatment in the future,” the researchers concluded. “It will also provide the opportunity to compare population and individual-level impacts in different settings, particularly those with mandatory HBV and HCV notification and capacity for data linkage to a range of administrative datasets.” – by Melinda Stevens

Disclosure: Waziry reports no relevant financial disclosures. Dore reports multiple financial relationships with AbbVie, Abbott Diagnostics, Bristol-Myers Squibb, Gilead Sciences, Janssen and Roche. Please see the study for a list of all other authors’ relevant financial disclosures.