Uptake of hepatocellular carcinoma surveillance after hepatitis c virus treatment: a retrospective audit

Background and Aims

Patients with Hepatitis C virus (HCV) infection and subsequent HCV-related cirrhosis are at risk of hepatocellular carcinoma (HCC), even after achieving sustained virological response (SVR12). Therefore, most liver organisations, including the European Association for the Study of the Liver (EASL), recommend HCC surveillance with biannual ultrasound scans (USS). However, uptake has consistently been poor, with suboptimal adherence to published guidance. This study aimed to evaluate uptake of HCC surveillance in those who have been treated for HCV and have METAVIR F4 fibrosis (cirrhosis) after HCV antiviral treatment (Direct Acting Antivirals – DAA) and to assess predictors of adherence to surveillance.

Methods

Data were retrospectively collected from a database of patients who received HCV treatment and subsequently enrolled onto an HCC surveillance programme between 1st January 2015 and 1st January 2018. Inclusion criteria consisted of patients aged > 18 years, who received HCV treatment, having pre-treatment METAVIR F4 fibrosis (cirrhosis). Patients with METAVIR F1-F3 fibrosis or with incomplete data were excluded. Patients were identified from the Sussex operational delivery network database. Data collection included patient demographics, alcohol use, intravenous drug use, type and location of HCV treatment, achievement of HCV cure (SVR12), and number of USS performed between 1st January 2015 and 1st March 2020.

Results

A total of 259 individuals were diagnosed and treated for HCV in Brighton with DAAs during the study period. A total of 96 individuals were excluded due to presence of F1-F3 fibrosis (73/96), incomplete data (11/96), death during the study period (6/96) or no longer meeting surveillance criteria (6/96). A total of 167 individuals (128 male), with a mean (±SD) age of 52 (±8.6) years at HCV diagnosis, were deemed suitable. 93% achieved SVR12 during the study period. 31% of participants received six monthly USS, with 69% of patients not meeting EASL recommendations. There was a significant difference in age between the adherent and non-adherent group (55.5±8.8 years vs 50.5±8.0 years; p=0.0004), with older individuals more likely to be adherent to HCC surveillance. There were no other statistically significant predictors of adherence to HCC surveillance observed.

Conclusions

Rates of surveillance adherence were poor over the study period, with only 31% of participants receiving six-monthly USS. Age was found to be the only statistically significant predictor of adherence to surveillance. These low rates highlight the need for interventions to improve HCC surveillance uptake amongst those with HCV cirrhosis following DAA treatment in Brighton.