Poor Adherence To Hepatocellular Carcinoma Screening In A Cohort Of Cirrhotic Patients After Hepatitis C Cure

Author: Francheville J W, Materniak S, Smyth D

Theme: Clinical Research Year: 2018

Background: After hepatitis C virus (HCV) cure, there remains a substantial risk of developing
hepatocellular carcinoma (HCC) in cirrhotic patients. As screening and early detection greatly
improves HCC prognosis, it is important to understand factors influencing adherence to post
sustained virologic response (SVR) care, especially in populations at risk of loss to follow-up.
Methods: Using a retrospective cohort study design, all cirrhotic patients achieving SVR
enrolled in the Hepatitis C positive and At-Risk (HEAR) database from April 2014 to April 2016
were extracted for analysis. Health records were reviewed for liver imaging during 6-month
intervals post-SVR up to February 28, 2018. Patients were categorized as 1) receiving all followup at 6-month intervals, and 2) receiving at least 1 liver image during follow-up. Univariate and
multivariate odds ratios were calculated for variables which may impact HCC surveillance.
Results: 49 cirrhotic patients were included with a mean follow-up time of 845.6 days (range
219-1043). Four patients (8.2%) had appropriate HCC surveillance at all 6-month intervals while
57.1% (n=28) had at least 1 liver image performed.
In univariate analysis, individuals under age 60, those incarcerated or unemployed were
significantly less likely to having any imaging performed post SVR; however multivariate
analysis did not show any single factor to be predictive of HCC surveillance. Of the 28 patients
who received at least 1 liver image, 3 (10.7%) had confirmed HCC.
Conclusion: Sub-optimal engagement in HCC surveillance was identified in a cohort of cirrhotic
patients after HCV cure. Results did indicate higher percentages not receiving imaging follow-up
among injection drug users, prisoners, unemployed persons and those with less education, but
the small numbers limited the power of the study. Comprehensive strategies to ensure post
SVR clinical care among cirrhotic patients are essential for early detection of HCC.
Disclosure of Interest Statement: Dr. Smyth reports grants and personal fees from Merck,
Gilead and Abbvie. Ms. Materniak reports affiliation with an outside non-profit organization who
receives grants and/or sponsorships from Abbvie, Gilead, and Merck. No pharmaceutical grants
were received in the development of this study.

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