Hepatitis C: Hepatocellular carcinoma, mortality, and the impact of treatment

Abstract

Hepatitis C (HCV) infection is the most common bloodborne illness in the United States and the prevalence is highest in those born between 1945 and 1965. Most of those with HCV infection in this cohort have been infected for decades and some are now experiencing the long-term consequences of HCV infection, including cirrhosis and hepatocellular carcinoma. At the same time, this cohort is just reaching the age of eligibility for Medicare. The introduction of new treatment protocols including direct-acting antivirals for HCV infection has resulted in better outcomes for those undergoing treatment with many achieving a cure of their HCV infection. Despite an awareness of the potential burden of disease from HCV infection in this cohort, there is still a lack of information regarding hepatocellular carcinoma outcomes in persons with HCV and the impact of treatment for HCV outcomes and transmission. Using the Surveillance, Epidemiology, and End Results data linked to Medicare claims, this research describes (1) changes in risk factors for hepatocellular carcinoma, including HCV infection, over time and (2) differences in outcomes of persons with hepatocellular carcinoma by HCV infection status in the Medicare population. In addition, a state transition model with a transmission equation was used to compare the impact of treatment on mortality and HCV transmission using direct-acting antivirals to treat persons born between 1945 and 1965 in two risk populations, persons who inject drugs and persons who don't inject drugs. Overall, this research adds to our understanding of the consequences of HCV-infection-related hepatocellular carcinoma and the impact of treatment in the population with the highest prevalence of HCV infection.