Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris, France.
Unité d'Hépatologie, Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Paris, France.
J Viral Hepat. 2019 Dec;26(12):1489-1492. doi: 10.1111/jvh.13186. Epub 2019 Aug 22.
There is still some controversy over a potentially increased short-term risk of developing hepatocellular carcinoma (HCC) after the initiation of direct-acting antiviral (DAA) therapy, even though a decreased long-term risk of HCC has been reported following a sustained virological response in patients with chronic hepatitis C virus (HCV) infection. We characterized the time-varying effect of DAAs on the risk of the occurrence of HCC in patients with cirrhosis and HCV infection. We analysed patients with cirrhosis and chronic HCV infection from the ANRS CO22 HEPATHER cohort study. We excluded patients with active HBV coinfection, liver transplantation or a past history of HCC. We used a flexible weighted effect cumulative exposure Cox model to characterize the time-varying effect of DAAs on the risk of HCC. A total of 3595 patients, mean age 59.3 years old, 65% men, were eligible for the study. Median follow-up was 36.8 months (IQR 24.6-47.1). DAAs were started during follow-up in 3292 patients. Three hundred and fifty-six HCCs were reported (275 treated, 81 untreated). Overall, a constant decrease in the risk of occurrence of HCC (vs untreated) was found from the start of treatment. Results were similar in patients without a history of decompensated cirrhosis (DC). Analysis of patients with a past history of DC showed a nonsignificant increase in the occurrence of HCC over the first 6 months, while the HR was significantly decreased at 14 months. These findings support the urgent initiation of DAAs in all patients.
尽管有报道称慢性丙型肝炎病毒 (HCV) 感染患者持续病毒学应答后 HCC 的长期风险降低，但直接作用抗病毒 (DAA) 治疗开始后 HCC 发生的短期风险增加仍存在一些争议。我们描述了 DAA 对肝硬化和 HCV 感染患者 HCC 发生风险的时变影响。我们分析了来自 ANRS CO22 HEPATHER 队列研究的肝硬化和慢性 HCV 感染患者。我们排除了 HBV 合并感染、肝移植或 HCC 既往史的患者。我们使用灵活加权效应累积暴露 Cox 模型来描述 DAA 对 HCC 风险的时变影响。共有 3595 名患者符合条件，平均年龄 59.3 岁，65%为男性。中位随访时间为 36.8 个月（IQR 24.6-47.1）。在随访期间，3292 名患者开始使用 DAA。报告了 356 例 HCC（275 例治疗，81 例未治疗）。总体而言，从治疗开始，我们发现 HCC 发生风险（与未治疗相比）持续降低。在无失代偿性肝硬化 (DC) 病史的患者中，结果相似。对有 DC 病史的患者的分析显示，在最初 6 个月内 HCC 的发生略有增加，但在 14 个月时 HR 显著降低。这些发现支持在所有患者中紧急启动 DAA。
