BURDEN OF HEPATOCELLULAR CARCINOMA AND PERSISTENT HBV/HCV PROTEIN EXPRESSION AMONG PATIENTS WITH ADVANCED LIVER DISEASE IN PAKISTAN: EVIDENCE FROM A TEN-YEAR RETROSPECTIVE STUDY
Author(s)
Saima Mushtaq, PhD1, Amjad Khan, PhD1, Arsalan Khan, MS2, Yu Fang, PhD3.
1Department of Pharmacy, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China, 2Center For Drug Safety and Policy Research, School of Pharmacy, Xi'an Jiaotong University, Xi’an, China, 3Department of Pharmacy, Xi'an Jiaotong University, Xi'an, China.
1Department of Pharmacy, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China, 2Center For Drug Safety and Policy Research, School of Pharmacy, Xi'an Jiaotong University, Xi’an, China, 3Department of Pharmacy, Xi'an Jiaotong University, Xi'an, China.
OBJECTIVES: Hepatocellular carcinoma (HCC) is a major consequence of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and places a substantial clinical and economic burden on health systems. In Pakistan, where viral hepatitis remains highly prevalent, real-world evidence on HCC burden and tissue-level viral persistence is limited. This study assessed the burden of HCC among patients with advanced liver disease and evaluated persistent HBV and HCV viral protein expression in liver cancer tissues.
METHODS: This retrospective real-world study analyzed ten years of patient data from a specialized liver care and transplantation setting in Pakistan, collected between December 2010 and September 2020. The frequency of HCC was assessed among patients admitted with liver-related complications. To explore viral persistence, immunohistochemistry was performed on explanted liver tissues and liver resection samples from patients with HBV- or HCV-associated HCC. HCV non-structural protein 5B and HBV X protein expression were evaluated using qualitative immunohistochemistry scoring. Data were analyzed using R software.
RESULTS: Among 1,384 patients with liver-related complications, HCC was identified in 256 patients, representing 18.5% of the study population. HCC occurrence differed significantly by age and gender, with a higher burden observed among male patients. Among HCV-associated HCC samples, 13 of 16 patients showed low-level HCV NS5B protein expression, while three patients demonstrated moderate-to-high expression. Among HBV-associated HCC samples, HBV X protein expression was detected with variable staining intensity across evaluated tissues, suggesting ongoing viral activity in hepatocytes.
CONCLUSIONS: This study highlights a substantial HCC burden among patients with advanced liver disease in Pakistan and provides tissue-level evidence of HBV and HCV viral persistence. The findings support the need for stronger hepatitis screening, timely antiviral management, risk-based HCC surveillance, and improved liver cancer prevention strategies. Strengthening real-world evidence systems may help guide clinical decision-making, resource allocation, and public health planning in high-burden settings.
METHODS: This retrospective real-world study analyzed ten years of patient data from a specialized liver care and transplantation setting in Pakistan, collected between December 2010 and September 2020. The frequency of HCC was assessed among patients admitted with liver-related complications. To explore viral persistence, immunohistochemistry was performed on explanted liver tissues and liver resection samples from patients with HBV- or HCV-associated HCC. HCV non-structural protein 5B and HBV X protein expression were evaluated using qualitative immunohistochemistry scoring. Data were analyzed using R software.
RESULTS: Among 1,384 patients with liver-related complications, HCC was identified in 256 patients, representing 18.5% of the study population. HCC occurrence differed significantly by age and gender, with a higher burden observed among male patients. Among HCV-associated HCC samples, 13 of 16 patients showed low-level HCV NS5B protein expression, while three patients demonstrated moderate-to-high expression. Among HBV-associated HCC samples, HBV X protein expression was detected with variable staining intensity across evaluated tissues, suggesting ongoing viral activity in hepatocytes.
CONCLUSIONS: This study highlights a substantial HCC burden among patients with advanced liver disease in Pakistan and provides tissue-level evidence of HBV and HCV viral persistence. The findings support the need for stronger hepatitis screening, timely antiviral management, risk-based HCC surveillance, and improved liver cancer prevention strategies. Strengthening real-world evidence systems may help guide clinical decision-making, resource allocation, and public health planning in high-burden settings.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO212
Topic
Clinical Outcomes, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Relating Intermediate to Long-term Outcomes
Disease
Gastrointestinal Disorders, Infectious Disease (non-vaccine), Oncology