b'Hepatitis C Cure Doesnt Always Prevent Hepatocellular Carcinoma Development u From Page 59attheVeteransAffairsPugetSound HealthcareSystemandprofessorof GastroenterologyattheUniversity ofWashington,bothinSeattle,and colleagues. 1The risk is not same for all veterans with cirrhosis or, as the researchers dis-covered, for all veterans without cirrho-sis at the time of treatment. Theteamanalyzedoutcomesfor 48,135veteranswhoachievedSVR between2000and2015.Ofthose, 9,784 had cirrhosis prior to treatment for HCV. Direct-acting antiviral (DAA) onlyregimenswereusedin29,033 Source: Dash S, Aydin Y, Widmer KE, Nayak L. Hepatocellular Carcinoma Mechanisms Associated with Chronic HCV Infection patients,while19,102receivedinter- and the Impact of Direct-Acting Antiviral Treatment. J Hepatocell Carcinoma. 2020;7:45-76. Published 2020 Apr 15. feron-based therapies. doi:10.2147/JHC.S221187https://pubmed.ncbi.nlm.nih.gov/32346535/Atotalof1,509patientsdeveloped HCC more than 180 days after treat- however. Among veterans without cir- annual incidence from 1.4% in Year 1 ment initiation. Patients who developedrhosis at the time of treatment, thoseto 0.5% in Year 4. HCC within 180 days of treatment ini- who had FIB-4 scores of 3.25 or higherIn both groups, the decline was sta-tiation were excluded from the study. hadanabsoluteHCCriskofmoretistically significant, but the researchers Theresearchersfoundthattheriskthan 2% per year. Notably, about 80%cautioned that they were only able to ofHCCwassignificantlyassociatedof patients without cirrhosis who hadevaluate patients for four years because withcirrhosisandFibrosis-4(FIB-4)scores of 3.25 prior to treatment expe- of the relative newness of the therapy. liver fibrosis score prior to treatment.rienced a drop in FIB-4 within a yearIninterferon-treatedveterans,the Veteranswithpretreatmentcirrhosisof achieving SVR, which reduced theirresearchersidentifiednodiscernable and FIB-4 of 3.25 or higher before andrisk below 1% annually. decline in HCC risk over time with 10 afterachievingSVRondirect-actingTheresearchersfoundthat,amongyears of data available.antiviral therapies had an annual inci- DAA-treated patients, the annual inci- Because of the high risk of HCC, the dence of HCC of about 5%. Those thatdenceofHCCdeclinedovertime.VA recommends regular screening for hadFIB-4scoresbelow3.25beforeThose who had FIB-4 scores of 3.25all veterans with cirrhosis. Ioannou and and after treatment had a much loweror greater prior to treatment saw a drophiscolleaguesrecommendedexpand-annual incidence, less than 1%. from 3.8% in Year 1 to 2.4% in Year 4.ingsurveillancetoincludeveterans Not all veterans who had not devel- Veterans with FIB-4 scores below 3.25who had FIB-4 of 3.25 or higher, even opedcirrhosiswereintheclear,atinitiationexperiencedadeclineinwithout cirrhosis.InlightofHCCriskandincreased screening,VAisexpandingitsfor-mulary, including therecent addition The risk is not same for all veterans with cirrhosisoflenvatinib,marketedasLenvima, which is the latest drug approved for or, as the researchers discovered, for all veteransfirst-line treatment of the cancer. without cirrhosis at the time of treatment.o Therhcc r isKF acTorsSuccessfully driving down the rate of hepatocellular carcinoma at the VA re-quiresunderstandingthemechanisms 2020 COMPENDIUM OF FEDERAL MEDICINE 67'