Ioannou GN, et al. - The authors aspired to ascertain the effect of direct-acting antiviral (DAA)-induced sustained virologic response (SVR) on hepatocellular carcinoma (HCC) risk. They concluded that DAA-induced SVR was correlated with a 71% reduction in HCC risk. Compared to treatment with interferon, treatment with DAAs was not associated with increased HCC risk.

• From 1/1/1999 to 12/31/2015, the authors identified 62,354 patients who initiated antiviral treatment in the Veterans Affairs (VA) national healthcare system, including 35,871 (58%) interferon-only regimens, 4535 (7.2%) DAA+interferon regimens and 21,948 (35%) DAA-only regimens.
• Until 6/15/2017, they retrospectively followed patients to identify incident cases of HCC.
• Cox proportional hazards regression was used to ascertaining the association between SVR and HCC risk or between type of antiviral regimen (DAA-only vs DAA+interferon vs Interferon-only) and HCC risk.

• During a mean follow-up of 6.1 years, the authors identified 3271 incident cases of HCC diagnosed at least 180 days after initiation of antiviral treatment.
• In patients with cirrhosis and treatment failure, the incidence of HCC was highest (3.25 per 100 patient-years), followed by cirrhosis and SVR (1.97), no cirrhosis and treatment failure (0.87) and no cirrhosis and SVR (0.24).
• In multivariable models, SVR was correlated with a significantly decreased risk of HCC irrespective of whether the antiviral treatment was DAA-only (adjusted hazard ratio [AHR] 0.29, 95% CI 0.23-0.37), DAA+interferon (AHR 0.48, 95% CI 0.32-0.73) or interferon-only (AHR 0.32, 95% CI 0.28-0.37).
• Compared to receipt of an interferon-only regimen, receipt of a DAA-only or DAA+interferon regimen was not correlated with increased HCC risk.