SAN FRANCISCO, Nov. 16, 2015 /PRNewswire/ -- The numbers of patients with cirrhosis and hepatocellular carcinoma (HCC) are predicted to rise in the near future but by how much and from which causes is still unclear. Lauren Beste, MD MSc, of the Veterans Affairs (VA) Puget Sound Health Care System and the University of Washington in Seattle, presented the result of a national retrospective cohort of VA patients at the annual meeting of the American Association for the Study of Liver Diseases. Dr. Beste and her colleagues included all VA patients diagnosed with cirrhosis and HCC between 2001 and 2013.
Hepatitis C virus (HCV) was present in many of those patients and reached a peak of 48 percent in patients with cirrhosis and 68 percent of patients with HCC by 2013. The cure rates for direct acting antivirals now used to treat patients with HCV will obviously affect the number of patients with HCV who would have progressed to cirrhosis and HCC. Prevalence of alcoholic liver disease, the second most common cause of cirrhosis, remained fairly constant over the study period though it declined as a proportionate cause because of the growing impact of HCV. The implications of nonalcoholic fatty liver disease (NAFLD) and an American population facing an obesity epidemic for adults and children have yet to be fully considered.
The unadjusted data from this study demonstrated that over the study period:
- Incidence of HCC increased by 265 percent
- Mortality in patients with cirrhosis increased by 51 percent
- Mortality in patients with HCC increased by 285 percent
"Each of the three top causes of cirrhosis and HCC is potentially preventable. Practicing in the clinic every day reminds me that we don't have unlimited time to address the big drivers of chronic liver disease like HCV, alcoholic liver disease, and NAFLD, said Dr. Beste. "HCV is an attractive target because it can be readily treated. The VA system, in particular, has mobilized an incredible effort to expand antiviral treatment to patients in need of it. However, delivering effective treatments for alcohol use disorders and NAFLD risk factors, like obesity, is a huge challenge for which the field doesn't have immediate or easy solutions."
HCV was the overwhelming driver of the rise in the prevalence of cirrhosis and HCC, with "much smaller contributions from NAFLD and alcoholic liver disease." Dr. Beste and colleagues concluded that if current trends continue in the future, the number of patients with cirrhosis will peak in approximately 2021. The incidence of HCC continues to rise, with no sign of a plateau.
"The prevalence of cirrhosis is still rising but appears to be leveling off. The burden of HCC is rising dramatically, with no sign of a slowdown. HCV is driving these trends, with alcoholic liver disease and NAFLD making up the majority of other cases" said Dr. Beste. "All other causes, combined, accounted for just 7% of cirrhosis and 7% of HCC."
Dr. Beste concluded, "Our study shows that the burden of cirrhosis and particularly HCC will continue to increase for years to come. This will have important implications for the VA system and for the general US population. All three of the leading causes of liver disease—HCV, alcoholic liver disease, and NAFLD—are potentially treatable. We have an opportunity to mitigate the effects of these underlying diseases if we invest now in treating them."
Abstract title: Trends in the burden of cirrhosis and hepatocellular carcinoma by underlying liver disease in US veterans from 2001-2013
AASLD is the leading medical organization for advancing the science and practice of hepatology. Founded by physicians in 1950, AASLD's vision is to prevent and cure liver diseases. This year's Liver Meeting®, held in San Francisco, CA, November 14-17, will bring together more than 9,000 researchers from 55 countries.
A pressroom will be available from November 13 at the annual meeting. For copies of abstracts and press releases, or to arrange researcher interviews, contact Gregory Bologna at 703-299-9766.
Press releases and all abstracts are available online at www.aasld.org.
Media Contact: Gregory Bologna
Press Room: November 13 – 17, 2015
Moscone West Convention Center, San Francisco, CA
Researcher: Lauren A. Beste, MD MSc
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SOURCE American Association for the Study of Liver Diseases (AASLD)