Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Humanity and Health Medical Center, Hong Kong SAR, China.
Hepatol Int. 2019 Nov;13(6):649-661. doi: 10.1007/s12072-019-09988-7. Epub 2019 Sep 20.
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.
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。