遗传性出血性疾病患者慢性丙型肝炎病毒感染成功治疗前后的肝脏相关并发症。
Liver-related complications before and after successful treatment of chronic hepatitis C virus infection in people with inherited bleeding disorders.
机构信息
Van Creveldkliniek, Department of Benign Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
出版信息
Haemophilia. 2023 Jan;29(1):106-114. doi: 10.1111/hae.14668. Epub 2022 Oct 2.
INTRODUCTION
With availability of direct-acting antivirals (DAA), most persons with inherited bleeding disorders are currently cured of hepatitis C virus (HCV) infection. The risk of liver-related complications following HCV cure has not been reported for this population.
AIM
Reporting liver-related complications during long-term chronic HCV infection and following sustained virological response (SVR) in this population.
METHODS
Retrospective follow-up of a prospective single-centre cohort of HCV antibody-positive persons with inherited bleeding disorders. Primary endpoint was liver-related complications [hepatocellular carcinoma (HCC), decompensated cirrhosis, bleeding gastroesophageal varices]. Liver-related complications were reported separately during chronic HCV and following SVR, stratified for interferon-based and DAA-based SVR.
RESULTS
In total 309/381 (81%) HCV antibody-positive individuals developed chronic HCV infection. Median follow-up was 44 years [interquartile range (IQR): 34-50]. Liver-related complications occurred in 36/309 (12%) of individuals with chronic HCV infection after median 31 years of chronic infection. Of 199 individuals with SVR, 97 were cured with interferon-based regimens and 102 with DAA after median infection durations of 29 and 45 years, respectively. At end of follow-up, respectively, 21% and 42% had advanced fibrosis or cirrhosis. Post-SVR, seven (4%) individuals had a liver-related complication, mainly HCC (n = 4). Incidence of liver-related complications per 100 patient-years post-SVR follow-up was .2 for interferon-cured and 1.0 for DAA-cured individuals (p = .01).
CONCLUSION
Successful HCV treatment does not eliminate the risk of liver-related complications in persons with inherited bleeding disorders. Due to higher baseline risk, incidence was higher after DAA than interferon-based SVR. We advise continuing HCC surveillance post-SVR in all with advanced fibrosis or cirrhosis.
简介
随着直接作用抗病毒药物（DAA）的出现，大多数遗传性出血性疾病患者目前已治愈丙型肝炎病毒（HCV）感染。但目前尚未有关于此类人群在 HCV 治愈后发生肝脏相关并发症风险的报道。
目的
报告该人群在慢性 HCV 感染期间及持续病毒学应答（SVR）后的肝脏相关并发症。
方法
对 HCV 抗体阳性遗传性出血性疾病患者前瞻性单中心队列进行回顾性随访。主要终点是肝脏相关并发症[肝细胞癌（HCC）、失代偿性肝硬化、出血性胃食管静脉曲张]。根据干扰素和 DAA 治疗的 SVR 分层，分别报告慢性 HCV 期间和 SVR 后的肝脏相关并发症。
结果
总共 381 名 HCV 抗体阳性个体中有 309 名（81%）发展为慢性 HCV 感染。中位随访时间为 44 年[四分位距（IQR）：34-50]。在 309 名患有慢性 HCV 感染的个体中，有 36 名（12%）在感染后中位 31 年内发生了肝脏相关并发症。在 199 名获得 SVR 的个体中，97 名使用干扰素治疗方案，102 名使用 DAA，感染持续时间分别为 29 年和 45 年。在随访结束时，分别有 21%和 42%的个体存在晚期纤维化或肝硬化。在 SVR 后，有 7 名（4%）个体发生了肝脏相关并发症，主要为 HCC（n=4）。SVR 后随访期间每 100 患者年发生肝脏相关并发症的发生率分别为干扰素治愈组.2 和 DAA 治愈组 1.0（p=0.01）。
结论
成功治疗 HCV 并不能消除遗传性出血性疾病患者发生肝脏相关并发症的风险。由于基线风险较高，DAA 后 SVR 的发生率高于干扰素。我们建议对所有患有晚期纤维化或肝硬化的患者在 SVR 后继续进行 HCC 监测。
Zotero 插件