Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla.
Hospital Universitario de Donostia, San Sebastián.
AIDS. 2018 Jul 17;32(11):1423-1430. doi: 10.1097/QAD.0000000000001809.
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.
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.
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).
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.
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。
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。
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）。
在 HIV/HCV 合并感染患者中广泛使用 DAA 后，SVR 后 HCC 发生的频率并未增加。DAA 在短期内似乎不会影响既往治疗过 HCC 的患者 HCC 复发的概率。
