High-normal and abnormal alanine transaminase levels linked to increased risk of hepatoma following treatment for chronic hepatitis C.
Journal
Journal of the Formosan Medical Association = Taiwan yi zhi
ISSN
0929-6646
Date Issued
2025-02-06
Author(s)
Chen, Yen-Chun
Tsai, Pei-Chien
Huang, Chung-Feng
Chen, Chi-Yi
Hung, Chao-Hung
Chen, Chien-Hung
Tai, Chi-Ming
Cheng, Pin-Nan
Kuo, Hsing Tao
Mo, Lein-Ray
Lo, Ching Chu
Huang, Yi-Hsiang
Lin, Han-Chieh
Lee, Pei-Lun
Bair, Ming-Jong
Chang, Te-Sheng
Lin, Chun-Yen
Wang, Szu-Jen
Hsieh, Tsai-Yuan
Yang, Tzeng-Hue
Peng, Cheng-Yuan
Yang, Chi-Chieh
Chong, Lee-Won
Huang, Chien-Wei
Lin, Chih-Wen
Chu, Cheng-Hsin
Tsai, Ming-Chang
Chuang, Wan-Long
Tseng, Kuo-Chih
Yu, Ming-Lung
Abstract
The risk of hepatocellular carcinoma (HCC) is increased in patients with chronic hepatitis C (CHC) and elevated alanine transaminase (ALT) levels. The association between HCC and ALT levels after interferon (IFN) or direct-acting antivirals (DAA) therapy is unclear.
Patients with CHC receiving antiviral therapy were included in two large-scale cohorts in Taiwan (T-COACH and TACR). Posttreatment ALT levels were assessed at 24-weeks/12-weeks after the end-of-treatment with IFN/DAA. HCC risk after antiviral therapy were identified for evaluation.
Of 29,926 CHC patients enrolled in the study, 64%, 22.5%, and 13.5% had posttreatment healthy-normal (female, ≤19 U/L; male ≤30 U/L), high-normal (female, 19-40 U/L; male, 30-40 U/L), and abnormal (>40 U/L) ALT levels, respectively. During a median follow-up of 2.4 years, 1245 patients developed HCC. The 5-year cumulative HCC incidence was 11.2% and 5.2% in the abnormal and high-normal ALT groups, respectively, compared to 2.7% in the healthy ALT group. In Cox regression analysis, factors associated with a higher HCC risk were advanced fibrosis, abnormal and high-normal posttreatment ALT levels, cirrhosis, and old age; whereas a sustained virological response (SVR) was associated with a lower HCC risk. The aforementioned impacts of abnormal and high-normal posttreatment ALT levels were observed across the SVR, non-SVR, and non-cirrhotic subgroups.
Patients with CHC with high-normal and abnormal posttreatment ALT levels have an increased risk of HCC; thus, HCC surveillance is still necessary in this population.
Subjects
Chronic hepatitis C
Direct-acting antivirals
Hepatocellular carcinoma
Interferon
SDGs
Type
journal article