Impact of all-oral direct-acting antivirals on hepatocellular carcinoma in Vietnamese patients with chronic HCV genotype 1

Abstract

Introduction: Hepatitis C virus (HCV) genotype 1 is a significant cause of hepatocellular carcinoma (HCC) in Vietnam. Direct-acting antivirals (DAAs) are effective in achieving sustained virologic response (SVR), potentially reducing HCC incidence. This study evaluated how DAA regimens affect HCC incidence in Vietnamese patients with chronic liver disease related to HCV genotype 1.

Methodology: A retrospective cohort study was conducted with 450 HCV-1 patients treated with DAAs at the Liver Clinic, University Medical Center Ho Chi Minh City, Vietnam. Patients were followed for a median duration of 0.5 years. Treatment regimens included combinations of NS5A inhibitors with NS3/4A protease inhibitors or NS5B polymerase inhibitors. Data on demographics, baseline clinical characteristics (e.g., alpha-fetoprotein, albumin levels), and liver function were collected before initiating DAA treatment. Follow-up data, including SVR rates and HCC incidence, were assessed at the end of treatment and during the post-treatment observation period (median follow-up of 0.5 years). This approach allowed us to compare pre-treatment baseline data with post-treatment outcomes to evaluate the impact of DAA therapy on HCC risk factors and incidence.

Results: SVR was achieved in 94.8% of patients, with an HCC incidence of 1.1% at 1 year for SVR patients, versus 6.5% for non-SVR patients. Significant risk factors for HCC included hypoalbuminemia, elevated alpha-fetoprotein levels, and non-SVR status.

Conclusions: DAAs significantly reduce HCC incidence in Vietnamese patients with HCV-1; however, ongoing surveillance is essential for high-risk patients.