Ran Xiping, Xu Yang, Wang Ying, Zeng Cheng, Gong Chen, Wang Ni, Cai Dachuan
Department of Gastroenterology, Chonggang General Hospital, Chongqing, China.
Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Front Cell Infect Microbiol. 2025 Feb 3;15:1510939. doi: 10.3389/fcimb.2025.1510939. eCollection 2025.
HCV genotype (GT) 3 is associated with rapid liver disease progression. However, the liver disease progression and its risk factors in patients with HCV GT 3 infection after sustained virological response (SVR) following direct-acting antivirals (DAAs) remain unclear. Therefore, we aimed to investigate the liver disease progression of patients with GT 3 after SVR.
This was a retrospective cohort study of patients with HCV infection who achieved SVR by DAAs. The clinical outcome was overall liver disease progression (OLDP), defined as newly diagnosed compensated liver cirrhosis, decompensated liver cirrhosis, or hepatocellular carcinoma. The incidence of OLDP was evaluated by Kaplan-Meier analysis. Cox regression analysis identified the risk factors for OLDP.
A total of 409 patients (46.9% GT3) were followed for 43.7 (32.9, 58.7) months. The incidence of OLDP was higher in patients with GT 3 (4.63/100PY) than non-GT 3 (0.60/100PY; P < 0.001). According to Cox multivariate analysis, GT 3 was significantly associated with OLDP (HR 6.41, 95% CI 1.82 - 22.56; P=0.004). The predictors of OLDP in patients with GT 3 were HCV recurrence (HR 12.15, 95% CI 3.18 - 46.46; P < 0.001) and FIB-4 > 3.25 (HR 16.40, 95% CI 1.03 - 39.81; P = 0.046) at baseline.
HCV GT 3-infected patients remain at a higher risk of OLDP even after achieving SVR by DAAs, especially patients with advanced liver fibrosis and at high risk for reinfection or virological late relapse.
丙型肝炎病毒（HCV）基因3型（GT3）与肝病快速进展相关。然而，在接受直接抗病毒药物（DAA）治疗后获得持续病毒学应答（SVR）的HCV GT3感染患者中，肝病进展情况及其危险因素仍不明确。因此，我们旨在研究GT3患者在SVR后的肝病进展情况。
这是一项对通过DAA实现SVR的HCV感染患者的回顾性队列研究。临床结局为总体肝病进展（OLDP），定义为新诊断的代偿期肝硬化、失代偿期肝硬化或肝细胞癌。通过Kaplan-Meier分析评估OLDP的发生率。Cox回归分析确定OLDP的危险因素。
共对409例患者（46.9%为GT3）进行了43.7（32.9，58.7）个月的随访。GT3患者的OLDP发生率（4.63/100人年）高于非GT3患者（0.60/100人年；P<0.001）。根据Cox多因素分析，GT3与OLDP显著相关（风险比6.41，95%置信区间1.82 - 22.56；P = 0.004）。GT3患者中OLDP的预测因素为基线时HCV复发（风险比12.15，95%置信区间3.18 - 46.46；P<0.001）和FIB-4>3.25（风险比16.40，95%置信区间1.03 - 39.81；P = 0.046）。
即使通过DAA实现了SVR，HCV GT3感染患者仍有较高的OLDP风险，尤其是那些有晚期肝纤维化且再感染或病毒学晚期复发风险高的患者。
