Long-Term Survival and Cancer Risk in the Hepatitis C Virus-Infected Patients After Antiviral Treatment: A Nationwide Cohort Study

Abstract

Background: Exposure to the Hepatitis C virus (HCV) has been identified as one of the most critical risk factors for Hepatocellular carcinoma (HCC). Interferons and direct-acting antivirals (DAAs) have been used to treat HCV infection with high rates (95%) of prolonged virological response, a suitable safety profile, and good compliance rates. Methods: We obtained information from Taiwan's Health and Welfare Data Science Center. (HWDSC). In this observational cohort research, patients with HCV who received a diagnosis in Taiwan between 2011 and 2018 were included. Results: 78,300 untreated HCV patients were paired for age, sex, and index date with 39,150 HCV patients who received interferon or DAAs treatment. Compared to the control group, the Interferon or DAAs treatment sample has fewer low-income individuals and more hospitalization requirements. The percentage of kidney illness was reduced in the therapy group compared to the control group, but the treatment group had a greater comorbidity rate of gastric ulcers. Interferon or DAA therapy for HCV-infected patients can substantially lower mortality. All cancer diagnoses after HCV infection with interferon treatment aHR 95% CI = 0.809 (0.774-0.846), Sofosbuvir-based DAA aHR 95% CI = 1.009 (0.737-1.381) and Sofosbuvir free DAA aHR 95% CI = 0.944 (0.584-1.526) showing cancer-protective effects in the INF-treated cohort but not DAA. Conclusion: Following antiviral therapy, women appear to have a more substantial preventive impact than men against pancreatic, colorectal, and lung cancer. Interferon or DAAs treatment effect was more significant in the cirrhotic group.

Figure 1

Study population flow chart. The figure shows people with HCV infection who were included in the study. Index date of treatment group = first treatment day + 90 days. 1. Interferon (INF) has health insurance benefits (2010-2018). 2. Sofosbuvir-based direct-acting antivirals (DAAs), (Health insurance benefits only available after 2017). 3. Sofosbuvir-free DAAs, (health insurance benefits will be available after 2017). Finally, according to age (±2 year), sex, and hepatitis diagnosis date (within 6 months), the patients were paired (Index = treatment + 90 days). 78,300 people with suspected hepatitis C infection were selected without viral drug treatment, and 39,150 people were treated with viral drug.

Figure 2

7-year cumulative cancer incidence between the treatment and non-treatment groups was plotted using the KM curve. (A) All cause mortality, (B) All cancer mortality, (C) Stomach cancer, (D) Liver (biliary) cancer, (E) Hepatocellular carcinoma, (F) Galbladder cancer, (G) Pancreatic cancer, (H) Colorectal cancer, (I) Lung cancer, (J) Oral cancer, (K) Breast cancer, (L) Prostate cancer. aHR (95% CI): Adjusted hazard ratios with 95% confidence intervals.

Figure 3

Subgroup distribution analysis of mortality and cancer incidence between the treatment and non-treatment groups. (A) All cause mortality, (B) All cancer mortality, (C) Stomach cancer, (D) Liver (biliary) cancer, (E) Hepatocellular carcinoma, (F) Galbladder cancer, (G) Pancreatic cancer, (H) Colorectal cancer, (I) Lung cancer, (J) Oral cancer, (K) Breast cancer, (L) Prostate cancer. aHR (95% CI): Adjusted hazard ratios with 95% confidence intervals.

Figure 3

Subgroup distribution analysis of mortality and cancer incidence between the treatment and non-treatment groups. (A) All cause mortality, (B) All cancer mortality, (C) Stomach cancer, (D) Liver (biliary) cancer, (E) Hepatocellular carcinoma, (F) Galbladder cancer, (G) Pancreatic cancer, (H) Colorectal cancer, (I) Lung cancer, (J) Oral cancer, (K) Breast cancer, (L) Prostate cancer. aHR (95% CI): Adjusted hazard ratios with 95% confidence intervals.