BACKGROUND & AIMS Direct-acting antivirals (DAAs) are effective against hepatitis C virus and sustained virologic response is associated with reduced incidence of hepatocellular carcinoma (HCC). However, there is controversy over the use of DAAs in patients with active or treated HCC and uncertainty about optimal management of these patients. We aimed to characterize attitudes and practice patterns of hepatology practitioners in the United States regarding the use of DAAs in patients with HCC. METHODS We conducted a survey of hepatology providers at 47 tertiary care centers in 25 states. Surveys were sent to 476 providers and we received 279 responses (58.6%). RESULTS Provider beliefs about risk of HCC recurrence after DAA therapy varied: 48% responded that DAAs reduce risk, 36% responded that DAAs do not change risk, and 16% responded that DAAs increase risk of HCC recurrence. However, most providers believed DAAs to be beneficial to and reduce mortality of patients with complete responses to HCC treatment. Accordingly, nearly all providers (94.9%) reported recommending DAA therapy to patients with early-stage HCC who received curative treatment. However, fewer providers recommended DAA therapy for patients with intermediate (72.9%) or advanced (57.5%) HCC undergoing palliative therapies. Timing of DAA initiation varied among providers based on HCC treatment modality: 49.1% of providers reported they would initiate DAA therapy within 3 months of surgical resection whereas 45.9% and 5.0% would delay DAA initiation for 3-12 months and >1 year post-surgery, respectively. For patients undergoing transarterial chemoembolization (TACE), 42.0% of providers would provide DAAs within 3 months of the procedure, 46.7% would delay DAAs until 3-12 months afterward, and 11.3% would delay DAAs more than 1 year after TACE. CONCLUSIONS Based on a survey sent to hepatology providers, there is variation in provider attitudes and practice patterns regarding use and timing of DAAs for patients with HCC. Further studies are needed to characterize the risks and benefits of DAA therapy in this patient population.

中文翻译：

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肝细胞癌患者直接抗病毒治疗的提供者态度和实践模式。


背景和目的 直接作用抗病毒药物 (DAA) 对丙型肝炎病毒有效，持续的病毒学反应与肝细胞癌 (HCC) 发病率降低相关。然而，对于活动性或已治疗的 HCC 患者使用 DAA 存在争议，并且这些患者的最佳治疗也存在不确定性。我们的目的是了解美国肝病从业者对于 HCC 患者使用 DAA 的态度和实践模式。方法 我们对 25 个州 47 个三级护理中心的肝病提供者进行了调查。我们向 476 家提供商发送了调查，收到了 279 份回复 (58.6%)。结果 提供者对 DAA 治疗后 HCC 复发风险的看法各不相同：48% 的受访者认为 DAA 会降低风险，36% 的受访者认为 DAA 不会改变风险，16% 的受访者认为 DAA 会增加 HCC 复发风险。然而，大多数提供者认为 DAA 有利于并降低对 HCC 治疗完全缓解的患者的死亡率。因此，几乎所有提供者 (94.9%) 都报告推荐向接受治愈性治疗的早期 HCC 患者进行 DAA 治疗。然而，很少有医疗服务提供者建议接受姑息治疗的中度 (72.9%) 或晚期 (57.5%) HCC 患者接受 DAA 治疗。根据 HCC 治疗方式，不同提供者开始 DAA 的时间也有所不同：49.1% 的提供者表示他们将在手术切除后 3 个月内开始 DAA 治疗，而 45.9% 和 5.0% 的提供者会将 DAA 开始延迟 3-12 个月以及 >1 年。分别进行手术。对于接受经动脉化疗栓塞 (TACE) 的患者，42.0% 的提供者会在手术后 3 个月内提供 DAA，46.7% 的提供者会将 DAA 推迟到术后 3-12 个月，11.0% 的提供者会在手术后 3 个月内提供 DAA。3% 会将 DAA 推迟到 TACE 后 1 年以上。结论 根据对肝病提供者进行的一项调查，提供者对于 HCC 患者 DAA 的使用和时机的态度和实践模式存在差异。需要进一步研究来描述 DAA 治疗在该患者群体中的风险和益处。