Tesis

Insidensi dan Faktor-Faktor yang Memengaruhi Karsinoma Hepatoseluler pada Pasien Hepatitis Virus C yang Mencapai Sustained virological Response Setelah Pengobatan Direct Acting Antiviral = Incidence and Factors of Hepatocellular Carcinoma in Hepatitis C Virus Patients achieving Sustained virological Response after Direct-Acting Antiviral Treatment.

Latar belakang: Insidensi dan faktor risiko karsinoma hepatoseluler (KSH) pada pasien hepatitis C virus (HCV) yang sudah mencapai sustained virological response (SVR) pasca terapi direct acting antiviral (DAA) belum banyak diketahui. Mengingat terdapat perbedaan jenis DAA, genotype virus, dan profil pasien di Indonesia, dilakukan studi untuk menilai insidensi dan faktor-faktor yang memengaruhi KSH pada pasien HCV pasca SVR post terapi DAA. Tujuan: Mengetahui insidensi dan faktor-faktor yang memengaruhi kejadian KSH pada pasien HCV yang mencapai SVR pasca pengobatan DAA. Metode: Desain penelitian kohort retrospektif di RSUPN Cipto Mangunkusumo, sampel pasien HCV yang sudah SVR pasca terapi DAA tahun 2017 – 2019, diikuti hingga 2024. Pasien dilakukan skrining USG abdomen, AFP dan CT Scan abdomen 3 fase apabila terdapat indikasi. Dilakukan analisis deskriptif, bivariat dengan Fisher’s exact, dan multivariat dengan regresi logistik bila terdapat faktor risiko di analisis bivariat memberikan nilai p < 0,25. Hasil: Dari 180 subjek penelitian, insidensi dan rasio insidensi KSH pada populasi keseluruhan, sirosis dan non sirosis, mencapai 4,4% (rasio insidens 0,91 /100PY), 9,7% (rasio insidens 2,1/100PY), dan 0,9% (0,18/100 PY). Terdapat hubungan signifikan dari analisis bivariat variabel sirosis hepatis (RR 10,5; IK 95% (1,32 – 83,5); p =0,0073) dan DM tipe 2 (RR 8,47; IK 95% (2,3 – 31,1) p = 0,0048). Terdapat hubungan signifikan dari analisis multivariat variabel DM tipe 2 (aRR 3,1; IK 95% (0,86 – 3,83); p=0,002). Kesimpulan: Insidensi KSH mencapai 4,4% dari total populasi. DM tipe 2 memiliki hubungan yang signifikan terhadap kejadian KSH pada pasien HCV yang mencapai SVR pasca pengobatan DAA.
Kata kunci: insidensi, karsinoma hepatoseluler, hepatitis C virus, direct-acting antiviral, sustained virological response.


Background: The incidence and risk factors for hepatocellular carcinoma (HCC) in hepatitis C virus (HCV) patients who have achieved a sustained virological response (SVR) after direct acting antiviral (DAA) therapy are not well established. Considering there are differences in DAA types, virus genotypes, and patient profiles in Indonesia, this study was conducted to assess the incidence and factors influencing HCC in HCV patients after SVR post DAA therapy. Objective: To determine the incidence and factors influencing HCC in HCV patients achieving SVR after DAA treatment. Method: Retrospective cohort study conducted at Cipto Mangunkusumo National General Hospital, a sample of HCV patients who had SVR after DAA therapy in 2017 – 2019, followed until 2024. Patients were screened for abdominal ultrasound, AFP and 3-phase abdominal CT scan if indicated. Descriptive, bivariate analysis with Fisher's exact, and multivariate analysis with logistic regression, if there were risk factors in the bivariate analysis with p < 0.25. Results: Among 180 subjects, the incidence and incidence ratio of HCC in the overall population, cirrhotic and non-cirrhotic, consecutively, 4.4% (incidence ratio 0.91/100PY), 9.7% (incidence ratio 2.1/100PY), and 0.9% (0.18/100 PY). There was a significant correlation from the bivariate analysis from the variables liver cirrhosis (RR 10.5; CI 95% (1.32 – 83.5); p = 0.0073) and type 2 DM (RR 8.47; CI 95% (2, 3 – 31.1) p = 0.0048), In multivariate analysis, there were found significant correlation from type 2 DM variables (aRR 3.1; CI 95% (0.86 – 3.83); p=0.002). Conclusion: The incidence of HCC reaches 4.4% of the total population. Type 2 DM has significant correlation with the incidence of HCC in HCV patients who achieve SVR after DAA treatment.
Keywords: incidence, hepatocellular carcinoma, hepatitis C virus, direct-acting antiviral, sustained virological response.