No significant differences in hepatocellular carcinoma (HCC) risk were observed between direct-acting antiviral agent (DAAs) regimens consisting of different classes, according to study results presented at the Liver Meeting 2018.

The retrospective study aimed to determine the risk of incident, or de novo, HCC following different regimens of antiviral therapy.

The study authors explained, “We identified 33,137 patients who initiated HCV antiviral treatment in the Veterans Affair (VA) healthcare system between 12/06/2013 and 12/31/2015 with 1 of 4 DAA-only regimens (± ribavirin): paritaprevir/ritonavir/ombitasvir/ dasabuvir (ProD) (N=6,289), sofosbuvir (N=4,356), sofosbuvir+simeprevir (N=3,210), and ledipasvir/sofosbuvir (N=19,282).”

The study authors identified 741 new cases of HCC following antiviral treatment after a mean follow-up of 1.52 years (incidence: 1.47 per 100 patient-years). The highest HCC incidence reported was in patients treated with sofosbuvir+simeprevir (2.47 per 100 patient-years). Additionally, the HCC incidence was found to be 1.91 for patients treated with sofosbuvir, 1.26 for patients treated with ledipasvir/sofosbuvir, and 0.95 for patients treated with PrOD. 

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Results of the study also showed that the prevalence of cirrhosis, advanced fibrosis markers, thrombocytopenia, as well as other HCC risk factors differed greatly between the DAA-treated patients. Additionally, data showed that no significant differences existed in the HCC risk between the DAA regimens after baseline characteristics associated with HCC were adjusted for.

“There are no significant differences between DAA regimens belonging to different classes in HCC risk after antiviral treatment,” the study authors concluded. They added, “This suggests that DAAs do not have direct carcinogenic effects as it would be unlikely that different DAAs would have identical carcinogenic effects.”


Mun E, Green P, Berry K, Ioannou G. No Difference between Direct-Acting Antivirals for Hepatitis C in Hepatocellular Carcinoma Risk. Presented at AASLD The Liver Meeting 2018. Study number 0654.