HIV/丙型肝炎病毒合并感染患者应用无干扰素方案获得持续病毒学应答后发生肝细胞癌。

Hepatocellular carcinoma after sustained virological response with interferon-free regimens in HIV/hepatitis C virus-coinfected patients.

机构信息

Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla.

Hospital Universitario de Donostia, San Sebastián.

出版信息

AIDS. 2018 Jul 17;32(11):1423-1430. doi: 10.1097/QAD.0000000000001809.

DOI:10.1097/QAD.0000000000001809

PMID:29596108

Abstract

OBJECTIVE

To assess the possible association between the use of direct antiviral agents (DAA) and the risk of hepatocellular carcinoma (HCC) in HIV/hepatitis C virus (HCV)-coinfected patients.

METHODS

The GEHEP-002 cohort recruits HCC cases in HIV-infected patients from 32 centers from Spain. Three analyses were performed: the proportion of HCC cases after sustained virological response (SVR) and the evolution of this proportion over time, the frequency of HCC after SVR in HIV/HCV-coinfected patients with cirrhosis, and the probability of HCC recurrence after curative therapies among those undergoing HCV therapy.

RESULTS

Forty-two (13%) out of 322 HCC cases in HIV/HCV-coinfected patients occurred after SVR. Twenty-eight (10%) out of 279 HCC cases diagnosed during the years of use of IFN-based regimens occurred after SVR whereas this occurred in 14 (32.6%) out of the 43 HCC cases diagnosed in the all-oral DAA period (P < 0.0001). One thousand, three hundred and thirty-seven HIV/HCV-coinfected patients with cirrhosis achieved SVR in the cohort. The frequency of HCC after SVR declined from 15% among those cured with pegylated-IFN with ribavirin to 1.62 and 0.87% among those cured with DAA with and without IFN, respectively. In patients with previous HCC treated with curative therapies, HCC recurrence occurred in two (25%) out of eight patients treated with IFN-based regimens and four (21%) out of 19 treated with DAA-IFN-free regimens (P = 1.0).

CONCLUSION

The frequency of HCC emergence after SVR has not increased after widespread use of DAA in HIV/HCV-coinfected patients. DAA do not seem to impact on HCC recurrence in the short-term among those with previously treated HCC.

摘要

目的

评估直接抗病毒药物（DAA）的使用与 HIV/丙型肝炎病毒（HCV）合并感染患者肝细胞癌（HCC）风险之间的可能关联。

方法

GEHEP-002 队列从西班牙的 32 个中心招募 HIV 感染患者中的 HCC 病例。进行了三项分析：持续病毒学应答（SVR）后的 HCC 病例比例及其随时间的演变，肝硬化的 HIV/HCV 合并感染患者中 SVR 后的 HCC 发生率，以及接受 HCV 治疗的患者中根治性治疗后 HCC 复发的概率。

结果

在 HIV/HCV 合并感染患者中，42 例（13%）322 例 HCC 病例发生在 SVR 后。在 IFN 为基础的治疗方案使用期间诊断的 28 例（10%）HCC 病例中有 28 例发生在 SVR 后，而在全口服 DAA 期间诊断的 43 例 HCC 病例中有 14 例（32.6%）发生在 SVR 后（P<0.0001）。队列中 1337 例 HIV/HCV 合并感染伴肝硬化的患者达到 SVR。在通过聚乙二醇干扰素联合利巴韦林治愈的患者中，SVR 后 HCC 的发生率从 15%下降到通过 DAA 联合或不联合 IFN 治愈的患者中的 1.62%和 0.87%。在接受根治性治疗的既往 HCC 患者中，2 例（25%）接受 IFN 为基础的方案治疗的患者和 4 例（21%）接受 DAA-无 IFN 方案治疗的患者发生 HCC 复发（P=1.0）。