Setting the Record Straight: Utility and Outcomes in Patients With <scp>HCV</scp> Related <scp>HCC</scp>

The effectiveness of direct acting antiviral (DAA) therapy in patients with active hepatocellular carcinoma (HCC) is poorly defined. NHS England approved DAA therapy for all viraemic patients, including those with HCC. The aim of this retrospective study is to provide a real-life data of treatment outcomes in those with active HCC. Patients with HCV related HCC from the National Hepatitis C registry in South-East England between 2016 and 2023 were included. The primary outcome was to assess the HCV care cascade in patients with HCV related HCC (HCC cohort) in comparison with those with advanced fibrosis/cirrhosis without HCC (non-HCC cohort). 1518 HCV RNA-positive patients started DAA therapy. 92.4% (1403) were included in the non-HCC cohort and 7.6% (115) were included in the HCC cohort. The SVR rate in the HCC cohort was 87% (80/92) versus 94.5% (1126/1191) in the non-HCC cohort (p = 0.003). In the multivariate analysis, only the presence of HCC (OR 0.4 95% CI 0.2-0.9; p = 0.029) was associated with a lower probability of achieving SVR. SVR rates were 95.6%, 50%, 75% and 22.2% and the median overall survival (OS) was 80, 29, 17 and 3 months for BCLC 0-A/B/C/D respectively. OS was longer in those who achieved SVR. More than two thirds of patients with HCV-related HCC initiated and completed DAA therapies. This high level of treatment uptake has led to an acceptable cure rate. Treating patients with HCV and HCC should be viewed as an appropriate clinical standard to improve overall outcomes. However, DAA therapy should not be initiated in those with a short life expectancy.