Divisao de Gastroenterologia (Gastrocentro), Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR.
Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Clinics (Sao Paulo). 2021 Nov 19;76:e3186. doi: 10.6061/clinics/2021/e3186. eCollection 2021.
Despite higher rates of sustained virologic response (SVR), important concerns remain when patients with decompensated cirrhosis due to hepatitis C virus (HCV) are treated with direct-acting antiviral agents (DAA). Questions include efficacy, safety, and the magnitude of liver function improvement. Here, we aimed to evaluate HCV treatment data in this specific population in Brazil.
We included 85 patients with decompensated cirrhosis submitted to HCV therapy with DAA followed at two academic tertiary centers in the southeastern region of Brazil.
Seventy-nine patients (92.9%) were Child-Pugh (CP) score B, and six (7.1%) were CP score C. The mean MELD score was 12.86. The most common treatment was sofosbuvir plus daclatasvir±ribavirin for 24 weeks. The overall intention-to-treat (ITT) SVR rate was 87.4% (74/85) and modified-ITT 96.1% (74/77). ITT SVR was associated with lower baseline INR values (p=0.029). Adverse events (AE) occurred in 57.9% (44/76) of patients. Serious AE were reported in 12.8% (10/78), and were related to the presence of hepatic encephalopathy (p=0.027). SVR was associated with improvement in CP (p<0.0001) and MELD scores (p=0.021). Among baseline CP score B patients with SVR, 46% (29/63) regressed to CP score A. Ascites was independently associated with no improvement in liver function in patients who achieved SVR (p=0.001; OR:39.285; 95% CI:4.301-258.832).
Patients with decompensated HCV cirrhosis showed a high SVR rate with interferon-free therapy. Early liver function improvement occurred after successful HCV eradication. However, long-term follow-up of these patients after SVR remains strongly advised.
尽管直接作用抗病毒药物（DAA）治疗丙型肝炎病毒（HCV）所致失代偿性肝硬化患者的持续病毒学应答（SVR）率较高，但仍存在一些重要问题。这些问题包括疗效、安全性以及肝功能改善的程度。在这里，我们旨在评估巴西特定人群中的 HCV 治疗数据。
我们纳入了在巴西东南部的两个学术三级中心接受 DAA 治疗的 85 例失代偿性肝硬化患者。
79 例（92.9%）患者的 Child-Pugh（CP）评分为 B，6 例（7.1%）患者的 CP 评分为 C。平均 MELD 评分为 12.86。最常见的治疗方案是索磷布韦加达卡他韦±利巴韦林，疗程为 24 周。总体意向治疗（ITT）SVR 率为 87.4%（74/85），改良意向治疗（mITT）SVR 率为 96.1%（74/77）。ITT SVR 与较低的基线 INR 值相关（p=0.029）。76 例患者中有 57.9%（44/76）发生了不良反应（AE）。12.8%（10/78）的患者发生了严重的 AE，与肝性脑病的发生相关（p=0.027）。SVR 与 CP（p<0.0001）和 MELD 评分的改善相关（p=0.021）。在基线 CP 评分为 B 且 SVR 为阳性的患者中，46%（29/63）的患者 CP 评分降至 A。腹水是 SVR 患者肝功能无改善的独立预测因素（p=0.001；OR：39.285；95%CI：4.301-258.832）。
无干扰素治疗失代偿性 HCV 肝硬化患者的 SVR 率较高。成功清除 HCV 后早期肝功能改善。然而，强烈建议对这些患者在 SVR 后进行长期随访。
