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Hsu CC, Gopalakrishna H, Mironova M, Lee MH, Chen CJ, Yang HI, Wiese M, Chang KM, Wright EC, Abijo T, Feld JJ, Kaplan DE. Risk of Hepatocellular Carcinoma After Spontaneous Clearance of Hepatitis C Virus and in Noncirrhosis Chronic Hepatitis C Patients With Sustained Virological Response: A Systematic Review. Clin Infect Dis 2023; 77:S245-S256. [PMID: 37579210 PMCID: PMC10425144 DOI: 10.1093/cid/ciad380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
In a hepatitis C virus (HCV)-controlled human infection model (CHIM), healthy volunteers are inoculated with HCV and then treated. Residual hepatocellular carcinoma (HCC) risk after viral clearance is an important consideration when evaluating the CHIM. We estimate HCC risk in spontaneously cleared HCV and in noncirrhosis after sustained virological response (SVR) to HCV treatment in a systematic review and using data from 3 cohorts: German anti-D, Taiwan, and US Veterans Affairs (VA). For noncirrhosis SVR, the overall HCC rate is 0.33 per 100 patient-years in meta-analysis. HCC rates for the German, Taiwan, and US Veterans Affairs cohorts are 0, 0.14, and 0.02 per 100 patient-years, respectively. Past hepatitis B virus exposure was not accounted for in the Taiwan cohort, while VA patients were likely tested based on liver disease/risk factors, which may confound HCC outcomes. The German cohort with no HCC after 44 years is most comparable to the CHIM participants. Although it is difficult to precisely estimate HCC risk from an HCV CHIM, the data suggest the risk to be very low or negligible.
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Affiliation(s)
- Christine C Hsu
- Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Harish Gopalakrishna
- Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Maria Mironova
- Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Manfred Wiese
- Department of Hepatology, University Hospital Leipzig, East German HCV Study Group, Leipzig, Germany
| | - Kyong-Mi Chang
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Gastroenterology and Hepatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Elizabeth C Wright
- Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Tomilowo Abijo
- Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Jordan J Feld
- Department of Medicine, Division of Gastroenterology, Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada
- Toronto Viral Hepatitis Care Network, Toronto, Canada
| | - David E Kaplan
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Gastroenterology and Hepatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
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Darvishian M, Tang T, Wong S, Binka M, Yu A, Alvarez M, Alexander Velásquez García H, Adu PA, Jeong D, Bartlett S, Karamouzian M, Damascene Makuza J, Wong J, Ramji A, Woods R, Krajden M, Janjua N, Bhatti P. Chronic hepatitis C infection is associated with higher incidence of extrahepatic cancers in a Canadian population based cohort. Front Oncol 2022; 12:983238. [PMID: 36313680 PMCID: PMC9609415 DOI: 10.3389/fonc.2022.983238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/23/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Chronic infection with hepatitis C virus (HCV) is an established risk factor for liver cancer. Although several epidemiologic studies have evaluated the risk of extrahepatic malignancies among people living with HCV, due to various study limitations, results have been heterogeneous. METHODS We used data from the British Columbia Hepatitis Testers Cohort (BC-HTC), which includes all individuals tested for HCV in the Province since 1990. We assessed hepatic and extrahepatic cancer incidence using data from BC Cancer Registry. Standardized incidence ratios (SIR) comparing to the general population of BC were calculated for each cancer site from 1990 to 2016. RESULTS In total, 56,823 and 1,207,357 individuals tested positive and negative for HCV, respectively. Median age at cancer diagnosis among people with and without HCV infection was 59 (interquartile range (IQR): 53-65) and 63 years (IQR: 54-74), respectively. As compared to people living without HCV, a greater proportion of people living with HCV-infection were men (66.7% vs. 44.7%, P-value <0.0001), had comorbidities (25.0% vs. 16.3%, P-value <0.0001) and were socially deprived (35.9% vs. 25.0%, P-value <0.0001). The SIRs for liver (SIR 33.09; 95% CI 29.80-36.39), anal (SIR: 2.57; 95% CI 1.52-3.63), oesophagus (SIR: 2.00; 95% CI 1.17-2.82), larynx (SIR: 3.24; 95% CI 1.21-5.27), lung (SIR: 2.20; 95% CI 1.82-2.58), and oral (SIR: 1.78; 95% CI 1.33-2.23) cancers were significantly higher among individuals living with HCV. The SIRs for bile duct and pancreatic cancers were significantly elevated among both individuals living with (SIR; 95% CI: 2.20; 1.27-3.14; 2.18; 1.57-2.79, respectively) and without HCV (SIR; 95% CI: 2.12; 1.88-2.36; 1.20; 1.11-1.28, respectively). DISCUSSION/CONCLUSION In this study, HCV infection was associated with increased incidence of several extrahepatic cancers. The elevated incidence of multiple cancers among negative HCV testers highlights the potential contributions of screening bias and increased cancer risks associated with factors driving acquisition of infection among this population compared to the general population. Early HCV diagnosis and treatment as well as public health prevention strategies are needed to reduce the risk of extrahepatic cancers among people living with HCV and potentially populations who are at higher risk of HCV infection.
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Affiliation(s)
- Maryam Darvishian
- Cancer Prevention, BC Cancer, Vancouver, BC, Canada
- Cancer Control Research, BC Cancer Research Centre, Vancouver, BC, Canada
- *Correspondence: Maryam Darvishian,
| | - Terry Tang
- Cancer Prevention, BC Cancer, Vancouver, BC, Canada
| | - Stanley Wong
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mawuena Binka
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Amanda Yu
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | | | - Prince Asumadu Adu
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Dahn Jeong
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sofia Bartlett
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mohammad Karamouzian
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
- Human Immunodeficiency Virus (HIV)/Sexually Transmitted Infection (STI) Surveillance Research Center, and World Health Organization (WHO) Collaborating Center for Human Immunodeficiency Virus (HIV) Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Jean Damascene Makuza
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason Wong
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Alnoor Ramji
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ryan Woods
- Cancer Prevention, BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mel Krajden
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Janjua
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Parveen Bhatti
- Cancer Prevention, BC Cancer, Vancouver, BC, Canada
- Cancer Control Research, BC Cancer Research Centre, Vancouver, BC, Canada
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Darden M, Parker G, Monlezun D, Anderson E, Buell JF. Race and Gender Disparity in the Surgical Management of Hepatocellular Cancer: Analysis of the Surveillance, Epidemiology, and End Results (SEER) Program Registry. World J Surg 2021; 45:2538-2545. [PMID: 33893525 DOI: 10.1007/s00268-021-06091-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The existence of race and gender disparity has been described in numerous areas of medicine. The management of hepatocellular cancer is no different, but in no other area of medicine, is the treatment algorithm more complicated by local, regional, and national health care distribution policy. METHODS Multivariate logistic regression and Cox-regression were utilized to analyze the treatment of patients with hepatocellular cancer registered in SEER between 1999 and 2013 to determine the incidence and effects of racial and gender disparity. Odd ratios (OR) are relative to Caucasian males, SEER region, and tumor characteristics. RESULTS The analysis of 57,449 patients identified the minority were female (25.31%) and African-American (16.26%). All tumor interventions were protective (p < 0.001) with respect to survival. The mean survival for all registered patients was 13.01 months with conditional analysis, confirming that African-American men were less likely to undergo ablation, resection, or transplantation (p < 0.001). Women were more likely to undergo resection (p < 0.001). African-American women had an equivalent OR for resection but had a significantly lower transplant rate (p < 0.001). CONCLUSIONS Utilizing SEER data as a surrogate for patient navigation in the treatment of hepatocellular cancer, our study identified not only race but gender bias with African-American women suffering the greatest. This is underscored by the lack of navigation of African-Americans to any therapy and a significant bias to navigate female patients to resection potentially limiting subsequent access to definitive therapy namely transplantation.
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Affiliation(s)
- Michael Darden
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - Geoffrey Parker
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | | | - Edward Anderson
- University of Texas McCombs Healthcare Innovation Initiative, Austin, TX, USA
| | - Joseph F Buell
- Department of Surgery, Mission Health, HCA North Carolina Division, University of North Carolina, Asheville, NC, USA.
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Darvishian M, Butt ZA, Wong S, Yoshida EM, Khinda J, Otterstatter M, Yu A, Binka M, Rossi C, McKee G, Pearce M, Alvarez M, Wong J, Cook D, Grennan T, Buxton J, Tyndall M, Woods R, Krajden M, Bhatti P, Janjua NZ. Elevated risk of colorectal, liver, and pancreatic cancers among HCV, HBV and/or HIV (co)infected individuals in a population based cohort in Canada. Ther Adv Med Oncol 2021; 13:1758835921992987. [PMID: 33633801 PMCID: PMC7887683 DOI: 10.1177/1758835921992987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/13/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction: Studies of the impact of hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV mono and co-infections on the risk of cancer, particularly extra-hepatic cancer, have been limited and inconsistent in their findings. Methods: In the British Columbia Hepatitis Testers Cohort, we assessed the risk of colorectal, liver, and pancreatic cancers in association with HCV, HBV and HIV infection status. Using Fine and Gray adjusted proportional subdistribution hazards models, we assessed the impact of infection status on each cancer, accounting for competing mortality risk. Cancer occurrence was ascertained from the BC Cancer Registry. Results: Among 658,697 individuals tested for the occurrence of all three infections, 1407 colorectal, 1294 liver, and 489 pancreatic cancers were identified. Compared to uninfected individuals, the risk of colorectal cancer was significantly elevated among those with HCV (Hazard ration [HR] 2.99; 95% confidence interval [CI] 2.55–3.51), HBV (HR 2.47; 95% CI 1.85–3.28), and HIV mono-infection (HR 2.30; 95% CI 1.47–3.59), and HCV/HIV co-infection. The risk of liver cancer was significantly elevated among HCV and HBV mono-infected and all co-infected individuals. The risk of pancreatic cancer was significantly elevated among individuals with HCV (HR 2.79; 95% CI 2.01–3.70) and HIV mono-infection (HR 2.82; 95% CI 1.39–5.71), and HCV/HBV co-infection. Discussion/Conclusion: Compared to uninfected individuals, the risk of colorectal, pancreatic and liver cancers was elevated among those with HCV, HBV and/or HIV infection. These findings highlight the need for targeted cancer prevention and diligent clinical monitoring for hepatic and extrahepatic cancers in infected populations.
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Affiliation(s)
- Maryam Darvishian
- BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC V5Z 1L3, Canada
| | - Zahid A Butt
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Stanley Wong
- BC Centre for Disease Control, Vancouver, Canada
| | | | | | | | - Amanda Yu
- BC Centre for Disease Control, Vancouver, Canada
| | | | | | - Geoff McKee
- University of British Columbia, Vancouver, Canada
| | - Margo Pearce
- BC Centre for Disease Control, Vancouver, Canada
| | | | - Jason Wong
- BC Centre for Disease Control, Vancouver, Canada
| | - Darrel Cook
- BC Centre for Disease Control, Vancouver, Canada
| | - Troy Grennan
- BC Centre for Disease Control, Vancouver, Canada
| | - Jane Buxton
- BC Centre for Disease Control, Vancouver, Canada
| | - Mark Tyndall
- University of British Columbia, Vancouver, Canada
| | - Ryan Woods
- Cancer Control Research, BC Cancer Research Centre, Vancouver, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Vancouver, Canada
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer Research Centre, Vancouver, Canada
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Binka M, Janjua NZ, Grebely J, Estes C, Schanzer D, Kwon JA, Shoukry NH, Kwong JC, Razavi H, Feld JJ, Krajden M. Assessment of Treatment Strategies to Achieve Hepatitis C Elimination in Canada Using a Validated Model. JAMA Netw Open 2020; 3:e204192. [PMID: 32374397 PMCID: PMC7203608 DOI: 10.1001/jamanetworkopen.2020.4192] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
Importance Achievement of the World Health Organization (WHO) target of eliminating hepatitis C virus (HCV) by 2030 will require an increase in key services, including harm reduction, HCV screening, and HCV treatment initiatives in member countries. These data are not available for Canada but are important for informing a national HCV elimination strategy. Objective To use a decision analytical model to explore the association of different treatment strategies with HCV epidemiology and HCV-associated mortality in Canada and to assess the levels of service increase needed to meet the WHO elimination targets by 2030. Design, Setting, and Participants Study participants in this decision analytical model included individuals with hepatitis C virus infection in Canada. Five HCV treatment scenarios (optimistic, very aggressive, aggressive, gradual decrease, and rapid decrease) were applied using a previously validated Markov-type mathematical model. The optimistic and very aggressive treatment scenarios modeled a sustained annual treatment of 10 200 persons and 14 000 persons, respectively, from 2018 to 2030. The aggressive, gradual decrease, and rapid decrease scenarios assessed decreases in treatment uptake from 14 000 persons to 10 000 persons per year, 12 000 persons to 8500 persons per year, and 12 000 persons to 4500 persons per year, respectively, between 2018 and 2030. Main Outcomes and Measures Hepatitis C virus prevalence and HCV-associated health outcomes were assessed for each of the 5 treatment scenarios with the goal of identifying strategies to achieve HCV elimination by 2030. Results An estimated mean 180 142 persons (95% CI, 122 786-196 862 persons) in Canada had chronic HCV infection at the end of 2017. The optimistic and gradual decrease scenarios estimated a decrease in HCV prevalence from 180 142 persons to 37 246 persons and 37 721 persons, respectively, by 2030. Relative to 2015, this decrease in HCV prevalence was associated with 74%, 69%, and 69% reductions in the prevalence of decompensated cirrhosis, hepatocellular carcinoma, and liver-associated mortality, respectively, leading to HCV elimination by 2030. More aggressive treatment uptake (very aggressive scenario) could result in goal achievement up to 3 years earlier than 2030, although a rapid decrease in the initiation of treatment (rapid decrease scenario) would preclude Canada from reaching the HCV elimination goal by 2030. Conclusions and Relevance The study findings suggest that Canada could meet the WHO goals for HCV elimination by 2030 by sustaining the current national HCV treatment rate during the next decade. This target will not be achieved if treatment uptake is allowed to decrease rapidly.
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Affiliation(s)
- Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- University of British Columbia, Vancouver, Canada
| | - Jason Grebely
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Chris Estes
- Center for Disease Analysis, Lafayette, Colorado
| | - Dena Schanzer
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
| | - Jisoo A. Kwon
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Naglaa H. Shoukry
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
| | - Jeffrey C. Kwong
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- ICES, Toronto, Ontario, Canada
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, Colorado
| | - Jordan J. Feld
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- University of British Columbia, Vancouver, Canada
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More than just oncogenes: mechanisms of tumorigenesis by human viruses. Curr Opin Virol 2018; 32:48-59. [PMID: 30268926 DOI: 10.1016/j.coviro.2018.09.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 12/18/2022]
Abstract
Most humans are infected with at least one of the known human cancer viruses during their lifetimes. While the initial infection with these viruses does not cause major disease, infected cells can acquire cancer hallmarks, particularly upon immunosuppression or exposure to co-carcinogenic stimuli. Even though cancer formation represents a rare outcome of a viral infection, approximately one out of eight human cancers has a viral etiology. Viral cancers present unique opportunities for prophylaxis, diagnosis, and therapy, as demonstrated by the success of HBV and HPV vaccines and HCV antivirals in decreasing the incidence of tumors that are caused by these viruses. Here we review common characteristics and mechanisms of action of the human oncogenic viruses.
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