El-Wahab Ekram W Abd, Elgawad Waleed M Abd, Abdelaziz Mohamed S, Mikheal Ashraf I, Shatat Hanan Z
Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
High Institute of Public Health, Alexandria University, Alexandria, Egypt.
Am J Trop Med Hyg. 2022 Feb 28;106(5):1522-33. doi: 10.4269/ajtmh.21-0918.
The introduction of generic direct-acting antivirals (DAAs) in Egypt is associated with a superior cure rate of hepatitis C virus (HCV) infection. However, the course of progressive liver damage and developing liver related complications in patients with sustained virologic response (SVR) remain unclear. This study was designed to examine the long-term outcomes of generic DAA-induced virological cure in a real-life cohort of HCV patients with or without comorbid schistosomiasis. We prospectively enrolled a cohort of 506 recently cured HCV patients (437 Child-Pugh class A [Child-A] and 69 Child-Pugh class B [Child-B]). All patients were clinically evaluated at different time points during a 2-year follow-up (November 2018 to February 2021). Over the course of treatment and follow-up, 77 (15.2%) patients (42 [9.6%] Child-A and 35 [50.7%] Child-B) experienced complications at different time points. The overall mortality rate was approximately 1/1,000 person-years. The incidence of hepatic insufficiency was approximately 5.5/1,000 person-years, and that of de novo hepatocellular carcinoma (HCC) was approximately 8.3/1,000 person-years. A sustained improvement in liver indices up to 2 years of follow-up was observed. In the Cox regression model, pretreatment decompensated cirrhosis predicted the occurrence of adverse liver events and HCC after therapy. In conclusion, in HCV patients with advanced cirrhosis or coexisting hepatic schistosomiasis, generic DAA-induced SVR remains robust with favorable clinical outcomes although the risk of hepatocarcinogenesis cannot be eliminated. Surveillance of patients with treated HCV infection is an important aspect of postcure care for early detection and management of liver disease-related adverse events.
在埃及引入仿制药直接抗病毒药物（DAA）与丙型肝炎病毒（HCV）感染的更高治愈率相关。然而，持续病毒学应答（SVR）患者的进行性肝损伤病程以及发生肝脏相关并发症的情况仍不清楚。本研究旨在调查在有或无合并血吸虫病的HCV患者真实队列中，仿制药DAA诱导病毒学治愈的长期结局。我们前瞻性纳入了一组506例近期治愈的HCV患者（437例Child-Pugh A级[Child-A]和69例Child-Pugh B级[Child-B]）。在2年随访期间（2018年11月至2021年2月）的不同时间点对所有患者进行了临床评估。在治疗和随访过程中，77例（15.2%）患者（42例[9.6%] Child-A和35例[50.7%] Child-B）在不同时间点出现了并发症。总死亡率约为1/1000人年。肝功能不全的发生率约为5.5/1000人年，新发肝细胞癌（HCC）的发生率约为8.3/1000人年。观察到随访长达2年时肝脏指标持续改善。在Cox回归模型中，治疗前失代偿性肝硬化可预测治疗后不良肝脏事件和HCC的发生。总之，在晚期肝硬化或合并肝血吸虫病的HCV患者中，尽管不能消除肝癌发生风险，但仿制药DAA诱导的SVR仍然稳固，临床结局良好。对接受HCV感染治疗的患者进行监测是治愈后护理的一个重要方面，以便早期发现和管理肝脏疾病相关不良事件。
