Veterans with genotype 3 hepatitis C virus infection were 31% more likely to develop cirrhosis and 80% more likely to develop liver cancer than were patients with genotype 1 infection, reported the authors of a large observational retrospective study published in the July issue of Hepatology.
"Our findings have implications that involve the entire spectrum of care, from antiviral treatment to prevention and screening in patients with HCV genotype 3 infection," said Dr. Fasiha Kanwal, of the Michael E. DeBakey Veterans Affairs Medical Center in Houston, and her associates. "Given the accelerated progression to advanced liver disease, patients with HCV genotype 3 may serve as a high-risk group that will need to be prioritized in the era of new antiviral treatments."
Dr. Fasiha Kanwal
But all-oral combination therapy with sofosbuvir and ribavirin may not achieve the high levels of sustained virologic response (SVR) found for patients with genotype 2 infection, Dr. Kanwal and her associates noted. And even if highly effective treatments for genotype 3 infection eventually become available, approximately one-quarter of affected patients would have progressed to cirrhosis and therefore would already be at increased risk for hepatocellular carcinoma, the researchers added.
The study included 110,484 patients with HCV infection from the VA HCV Clinical Case Registry. About 70% of patients were Vietnam-era veterans, the investigators said. Patients were followed for an average of 5.4 years between 2000 and 2009, and a total of 8,337, or 7.5%, had genotype 3 infection, the researchers reported (Hepatology 2014;60:98-105).
After adjustment for factors such as age and year of birth, diabetes, body mass index, and antiviral treatment, patients with genotype 3 infection had the highest risk of developing cirrhosis and hepatocellular carcinoma among all HCV genotypes. Compared with genotype 1–infected patients, genotype 3–infected patients had a 31% higher risk for cirrhosis (adjusted hazard ratio, 1.31; 95% confidence interval, 1.22-1.39) and an 80% higher risk for hepatocellular carcinoma (aHR, 1.81; 95% CI, 1.61-2.03), the investigators added. Furthermore, a subgroup analysis of patients with cirrhosis showed that the risk of hepatocellular carcinoma was 44% higher in patients with genotype 3 infection than in patients with genotype 1 infection, the researchers said.
"These data are relevant to the thousands of HCV patients with genotype 3 infection, and to their physicians who provide care and counseling to this population," said Dr. Kanwal and her associates. They added that the data might help in prioritizing who should first receive future generations of direct-acting antivirals.
The Houston VA Health Services Research and Development Center of Excellence helped fund the study. The authors did not report conflicts of interest.