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APASL HCV 指南:DAA 治愈的 HCV 患者应如何监测 HCC 发生和 HBV 再激活。

APASL HCV guidelines of virus-eradicated patients by DAA on how to monitor HCC occurrence and HBV reactivation.

机构信息

Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.

Humanity and Health Medical Center, Hong Kong SAR, China.

出版信息

Hepatol Int. 2019 Nov;13(6):649-661. doi: 10.1007/s12072-019-09988-7. Epub 2019 Sep 20.

Abstract

In the direct-acting antiviral (DAA) era for hepatitis C virus (HCV) infection, sustained virological response (SVR) is very high, but close attention must be paid to the possible occurrence of hepatocellular carcinoma (HCC) and reactivation of hepatitis B virus (HBV) in patients with co-infection who achieved SVR in short term. HCC occurrence was more often observed in patients with previous HCC history. We found occurrence of HCC in 178 (29.6%) of 602 patients with previous HCC history (15.4 months mean follow-up post-DAA initiation) but, in contrast, in only 604 (1.3%) of 45,870 patients without previous HCC history (18.2 months mean follow-up). Thus, in these guidelines, we recommend the following: in patients with previous HCC history, surveillance at 4-month intervals for HCC by ultrasonography (US) and tumor markers should be performed. In patients without previous HCC history, surveillance at 6- to 12-month intervals for HCC including US is recommended until the long-term DAA treatment effects, especially for the resolution of liver fibrosis, are confirmed. This guideline also includes recommendations on how to follow-up patients who have been infected with both HCV and HBV. When HCV was eradicated in these HBsAg-positive patients or patients with previous HBV infection (anti-HBc and/or anti-HBs-positive), it was shown that HBV reactivation or HBV DNA reappearance was observed in 67 (41.4%) of 162 or 12 (0.9%) of 1317, respectively. For these co-infected patients, careful attention should be paid to HBV reactivation for 24 weeks post-treatment.

摘要

在丙型肝炎病毒 (HCV) 感染的直接作用抗病毒 (DAA) 时代,持续病毒学应答 (SVR) 非常高,但必须密切关注短期达到 SVR 的合并感染患者中肝细胞癌 (HCC) 和乙型肝炎病毒 (HBV) 再激活的可能发生。HCC 的发生更常见于有 HCC 既往史的患者。我们发现,在 602 例有 HCC 既往史的患者中(DAA 治疗开始后平均 15.4 个月随访)有 178 例(29.6%)发生 HCC,但相反,在 45870 例无 HCC 既往史的患者中(平均 18.2 个月随访)仅有 604 例(1.3%)发生 HCC。因此,在这些指南中,我们建议:对于有 HCC 既往史的患者,应通过超声(US)和肿瘤标志物每 4 个月监测 HCC。对于无 HCC 既往史的患者,建议每 6-12 个月监测 HCC,包括 US,直到确认长期 DAA 治疗效果,特别是肝纤维化的缓解。本指南还包括了关于如何对同时感染 HCV 和 HBV 的患者进行随访的建议。在这些 HBsAg 阳性或既往 HBV 感染(抗-HBc 和/或抗-HBs 阳性)患者中清除 HCV 后,分别有 67 例(41.4%)或 12 例(0.9%)观察到 HBV 再激活或 HBV DNA 再次出现。对于这些合并感染的患者,应在治疗后 24 周内密切注意 HBV 再激活。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a33f/6861433/3b813df7d92d/12072_2019_9988_Fig1_HTML.jpg

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