b'Hepatitis C Cure Doesnt Always Prevent HCC Development at VAVA Research Seeks to Determine Who Is at Highest HCC RiskBy Annette M. BoyleMore than 100,000 VA patients have been essentially cured ofCollege of Medicine, both in Houston, hepatitis C with direct-acting antiviral treatment. Even thoughandeditor-in-chiefofClinical GastroenterologyandHepatology HCV is the leading cause of hepatocellular carcinoma in thewhenshespokewithU.S.Medicine United States, curing the infection only reduces the risk; itlast year. Thirty percent to 40% of veterans had doesnt entirely eliminate it. Thats why the VA has continuedalready developed cirrhosis when they with research to determine who is at greatest risk of HCC andreceived treatment for HCV. Withmorethan30,000veteransat is looking at expanding screening. elevated risk of HCC, the VA has led national research into the relationship between HCV infection and treatment and development of liver cancer.HOUSTONInthelastsixyears,The risk [of HCC] remains high in the VA has cured chronic hepatitis Cpatientswhohaveprogressedtocir- c irrhosis andFiB-4(HCV) infections in more than 100,000rhosisalready,saidFasihaKanwal,[A]mong patients with established cir-veterans using direct-acting antivirals.MD,MSHS,aninvestigatorintherhosis before antiviral treatment, a sub-AsHCVhasbeentheleadingcauseClinical Epidemiology & Comparativestantial absolute risk of HCC persists of hepatocellular carcinoma (HCC) inEffectiveness Program at the Center forafterSVR,eventhoughitissignifi-the U.S. and the VA, curing the infec- InnovationsinQuality,Effectivenesscantly reduced compared to untreated tion reduces the risk of developing liverand Safety at the Michael E. DeBakeypatients and those who did not achieve cancer.VAMC, chief of the GastroenterologySVR, according to study by George N. Unfortunately, the risk is not entirelyand Hepatology Section at the BaylorIoannou, MD, MS, a gastroenterologist eliminated. Of the individuals who have chronic hepatitisCinfection,15%to20% will go on to develop cirrhosis of theWith more than 30,000 veterans at elevated risk liver. Patients with cirrhosis have 1% to 5% annual risk of developing HCC,of HCC, the VA has led national research into the according to the nationalCenters for Disease Control and Prevention. Thatrelationship between HCV infection and treatment risk doesnt go away immediately for patientswithcirrhosiswhoachieveand development of liver cancer.sustainedvirologicresponse(SVR) or cure.Continued on Page 67 u2020 COMPENDIUM OF FEDERAL MEDICINE 59'