title: Effectiveness of hepatitis C antiviral treatment in a USA cohort of veteran patients with hepatocellular carcinoma.
abstract: Hepatitis C virus (HCV) treatment for patients with hepatocellular carcinoma (HCC) was uncommon before direct-acting antiviral (DAA) medications. Real-world effectiveness of DAAs for HCV in patients with HCC is unclear. We describe rates of sustained virologic response (SVR) with DAA regimens by HCV genotype in patients with a history of HCC.
  
  
  
  We identified patients who initiated antiviral treatment between January 1, 2014 and June 30, 2015 in the national Veterans Affairs health care system. Regimens included sofosobuvir, ledipasvir/sofosbuvir, and paritaprevir/ritonavir/ombitasvir and dasabuvir with or without ribavirin. HCC patients were divided into those who were treated with liver transplantation after HCC diagnosis ("HCC/LT" group) and those treated with other modalities prior to antiviral therapy ("HCC" group).
  
  
  
  Of 17,487 HCV treatment recipients, 624 (3.6%) had prior HCC, including 142 with HCC/LT and 482 with HCC. Overall SVR was 91.1% in non-HCC, 74.4% in HCC, and 94.0% in HCC/LT. Among HCC patients, genotype 1 had the highest SVR overall (79.1% in HCC and 96.4% in HCC/LT), and genotype 3 the lowest (47.0% in HCC and 88.9% in HCC/LT). After adjustment for confounders, the presence of HCC was associated with lower likelihood of SVR overall (AOR 0.38 [95% CI 0.29, 0.48], p<0.001).
  
  
  
  HCV can be cured with DAAs in the majority of patients with prior HCC, and in virtually all HCC patients post-liver transplant. Deferral of HCV treatment until the post-transplant setting may be considered among HCC patients listed for transplantation.
  
  
  
  Over three-quarters of patients with hepatocellular carcinoma who have hepatitis C can achieve viral cure with direct-acting antiviral drugs. Among patients with hepatocellular carcinoma who subsequently received liver transplantation, over 90% of patients can achieve viral cure.
authors.affiliation: General Medicine Service, Veterans Affairs Puget Sound Health Care System, United States; Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, United States; Division of General Internal Medicine, University of Washington, United States. Electronic address: lab25@uw.edu.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beste
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, United States.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Green
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, United States.
authors.forename: Kristin
authors.initials: K
authors.lastname: Berry
authors.affiliation: Diagnostic Imaging Service, Veterans Affairs Puget Sound Health Care System, United States; Division of Interventional Radiology, University of Washington, United States.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kogut
authors.affiliation: Diagnostic Imaging Service, Veterans Affairs Puget Sound Health Care System, United States; Division of Interventional Radiology, University of Washington, United States.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Allison
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, United States; Gastroenterology Service, Veterans Affairs Puget Sound Health Care System, United States; Division of Gastroenterology, University of Washington, United States.
authors.forename: George N
authors.initials: GN
authors.lastname: Ioannou
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000821:virology*; D015331:Cohort Studies; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000821:virology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D014728:Veterans
chemical_list: D000998:Antiviral Agents
keywords: Ledipasvir/sofosbuvir; Liver transplant; Paritaprevir/ritonavir/ombitasvir and dasabuvir; Sustained virologic response