Hassany Sahar M, Hassan Wesam, Abo-Alam Hany, Khalaf Marwa, Nafeh Amany M, Nasr-Eldin Eman, Mostafa Ehab F
Tropical Medicine and Gastroenterology Department, Alrajhi University Hospital, Assiut University, Assiut, Egypt.
Hepatology Centre, Ministry of Heath, Assiut, Egypt.
Infect Drug Resist. 2020 Jun 18;13:1873-1880. doi: 10.2147/IDR.S241948. eCollection 2020.
In interferon-free era, direct-acting antiviral agents (DAAs) have achieved high eradication rates with an excellent safety profile since revolutionized the management of hepatitis c virus (HCV) patients. Published papers have suggested a possible increased incidence of hepatocellular carcinoma (HCC) after successful DAAs treatment. Other papers have been published about the problem but without conclusive results. Because of this debate, we aim to evaluate the effects of antiviral therapy (Sofosbuvir plus Daclatasvir with or without Ribavirin) on the de novo occurrence of HCC in patients with liver cirrhosis (LC).
A prospective cohort study has included 350 patients who have visited our center for HCV treatment. Pretreatment history, examination, complete blood picture, liver function tests, kidney function tests, HA1C for diabetic patients, HCV PCR, HBsAg, alpha-fetoprotein (AFP), and abdominal ultrasound have been done, also Child-Pogh (CP) and Model for End-Stage Liver Disease (MELD) score before treatment. These investigations have been repeated for 3 months after the end of treatment. Abdominal ultrasound (US) has been done for 3 months after treatment and every 4 months for 2 years after the end of treatment to detect HCC occurrence.
Patients age (58.11 ± 7.48), 55.4% of patients were males, 30.3% of patients were diabetic, 84.3% of them were treatment naïve and sustained virological response (SVR) occured in 94% of them. HCC occurrence after treatment was 6.7% in patients with SVR and 23.8% in patients with non-SVR (P value=0.016) during follow-up period. There is significant improvement of CP score. No significant changes in MELD score.
Treatment of HCV-related LC patients with sofosbuvir and daclatasvir with or without ribavirin for 3 or 6 months showed high SVR and significant improvement in CP score, but still at risk of HCC even if treated and should be followed up regularly according to screening programs with special meticulous attention to those with non-SVR.
在无干扰素时代，直接抗病毒药物（DAAs）彻底改变了丙型肝炎病毒（HCV）患者的治疗方式，实现了高根除率且安全性良好。已发表的论文表明，DAAs治疗成功后肝细胞癌（HCC）的发病率可能会增加。关于这个问题也有其他论文发表，但结果尚无定论。鉴于此争论，我们旨在评估抗病毒治疗（索磷布韦联合达卡他韦，联合或不联合利巴韦林）对肝硬化（LC）患者HCC新发的影响。
一项前瞻性队列研究纳入了350名到本中心接受HCV治疗的患者。进行了治疗前病史、检查、全血细胞计数、肝功能检查、肾功能检查、糖尿病患者的糖化血红蛋白、HCV PCR、乙肝表面抗原、甲胎蛋白（AFP）和腹部超声检查，同时记录了治疗前的Child-Pogh（CP）评分和终末期肝病模型（MELD）评分。治疗结束后3个月重复进行这些检查。治疗后3个月进行腹部超声（US）检查，治疗结束后2年每4个月进行一次检查以检测HCC的发生情况。
患者年龄为（58.11±7.48）岁，55.4%为男性，30.3%为糖尿病患者，84.3%为初治患者，94%实现了持续病毒学应答（SVR）。随访期间，SVR患者治疗后HCC发生率为6.7%，非SVR患者为23.8%（P值=0.016）。CP评分有显著改善。MELD评分无显著变化。
用索磷布韦和达卡他韦联合或不联合利巴韦林治疗HCV相关LC患者3或6个月，显示出高SVR率且CP评分有显著改善，但即使接受治疗仍有HCC风险，应根据筛查计划定期随访，尤其要特别密切关注非SVR患者。
