Trends in hepatocellular carcinoma among people with HBV or HCV notification in Australia (2000-2014)

Background & Aims This study evaluates trends in hepatocellular carcinoma (HCC) among people with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection in New South Wales (NSW), Australia between 2000 and 2014. Methods Data on HBV and HCV notifications between January 1993 and December 2012 were linked to the NSW Admitted Patients Data Collection database between July 2000 and June 2014 and NSW Registry of Births Deaths and Marriages. The burden, crude and age-standardised incidence of HCC based on first hospitalization were calculated. Results In NSW between 2000–2014, there were 54,399, 93,099 and 3,809 individuals notified with HBV, HCV and HBV/HCV coinfection respectively. There were 725 (1.3%) with HCC among those with HBV notification as compared to 1,309 with HCC (1.4%) in those with HCV notification. The population-level burden of new HCC cases per year has stabilised in the HBV cohort (53 in 2001 and 44 in 2013), but increased markedly in the HCV cohort (49 in 2001 to 151 in 2013). The age-standardised incidence rates of HCC (per 1,000 person-years) declined from 2.3 (95% confidence interval (CI) 1.4, 3.1) in 2001 to 0.9 (95% CI 0.6, 1.2) in 2012 among those with HBV and remained stable between 2001 (1.4; 95% CI 0.8, 1.9) and 2012 (1.5; 95% CI 1.2, 1.7) in those with HCV. Main factors associated with HCC in those with HBV included later study period (2005–2009; 2010–2014) (hazard ratio (HR) = 0.54, 95% CI 0.42, 0.70), male gender (HR = 4.50, 95% CI 3.6, 5.6), Asia-Pacific country of birth (HR = 3.84, 95% CI 2.58, 5.71) and alcohol dependency (HR = 2.84, 95% CI 1.95, 4.13). Main factors associated with HCC in those with HCV included male gender (HR = 2.56, 95% CI 2.20, 2.98), rural place of residence (HR = 0.73, 95% CI 0.62, 0.86), Asia-Pacific country of birth (HR = 2.37, 95% CI 1.99, 2.82) and alcohol dependency (HR = 3.90, 95% CI 3.39, 4.49). Conclusions Individual-level risk of HBV-related HCC has declined, suggesting an impact of more effective antiviral therapy from mid-2000s. In contrast, the interferon-containing HCV treatment era had no impact on individual-level HCV-related HCC risk and has seen escalating population-level HCC burden. Lay summary Individual-level risk of HBV-related HCC has declined, suggesting an impact of more effective antiviral therapy from mid-2000s. In contrast, the interferon-containing HCV treatment era had no impact on individual-level HCV-related HCC risk and has seen escalating population-level HCC burden.