Five-Year Follow-Up of Cured HCV Patients under Real-World Interferon-Free Therapy

SIMPLE SUMMARY: Hepatitis C virus (HCV) is the major factor responsible for hepatocellular carcinoma (HCC). Currently available treatments for HCV infection are short, simple, effective and safe. Long-term monitoring of patients is essential to demonstrate the efficacy of antiviral therapy, including the risk of HCC development. Since highly effective treatment options only became available in the middle of the past decade, we evaluated patients treated during this period five years after treatment. We have shown that the risk of death due to HCC as well as death due to HCV persists through 5 years of follow-up after successful treatment. Therefore, longer follow-up is necessary to assess the long-term risk of developing HCC, especially in patients with cirrhosis. ABSTRACT: (1) Background: Treatment of hepatitis C virus (HCV) infections with direct-acting antivirals (DAA) has demonstrated high efficacy and an excellent safety profile. The cured patients showed a sustained virological response and improved liver function, but also a continued risk of hepatocellular carcinoma (HCC) during the 2–3 years of follow-up after treatment; (2) Methods: A total of 192 patients out of 209 of the primary AMBER study were analyzed five years after treatment with ombitasvir/paritaprevir/ritonavir with or without dasabuvir and with or without ribavirin. Results: We confirmed that HCV clearance after DAA treatment is stable regardless of baseline liver fibrosis. We found that sustained virologic response is associated with a gradual but significant reduction in liver stiffness over 5 years. Liver function improved during the first 2 years of follow-up and remained stable thereafter. The risk of death due to HCC as well as death due to HCV persists through 5 years of follow-up after successful DAA treatment. However, in non-cirrhotic patients, it appears to clear up 3 years after treatment; (3) Conclusions: Monitoring for more than 5 years after curing HCV infection is necessary to assess the long-term risk of possible development of HCC, especially in patients with cirrhosis of the liver.