Kinetics of emergence of liver complications in hepatitis C virus infected patients and advanced fibrosis, with and without HIV-coinfection, after sustained virological response.
Por:
Corma-Gómez A, Macías J, Téllez F, Morano L, Rivero A, Serrano M, Ríos MJ, Vera-Méndez FJ, Santos M, Real LM, Palacios R, Santos IL, Geijo P, Imaz A, Merino D, Galindo MJ, Reus-Bañuls S, López-Ruz MÁ, Galera C, Pineda JA and RIS-HEP13 and GEHEP 011 study groups
Publicada:
1 nov 2021
Resumen:
OBJECTIVE: There is scarce available evidence on the distribution over time of liver complications emergence in hepatitis C virus (HCV)-infected patients who achieve sustained virological response (SVR) with direct-acting antiviral (DAA)-based therapy. Therefore, we aimed at describing the kinetics of liver-related events appearance in this setting. DESIGN: A multicentric prospective cohort study. METHODS: HCV-monoinfected and HIV/HCV-coinfected patients from GEHEP-011 cohort, whose inclusion criteria were had achieved SVR with DAA-based therapy; liver stiffness prior to starting treatment at least 9.5 kPa; and available liver stiffness measurement at SVR. SVR was considered as the baseline time-point. RESULTS: One thousand and thirty-five patients were included, 664 (64%) coinfected with HIV. Before DAA-based therapy, 63 (6.1%) individuals showed decompensated cirrhosis. After SVR, 51 (4.9%) patients developed liver complications. Median (Q1-Q3) time to the emergence of hepatic events was hepatic encephalopathy 11 (7-24) months, ascites 14 (6-29) months, hepatocellular carcinoma (HCC) 17 (11-42) months and portal hypertension gastrointestinal bleeding (PHGB) 28 (22-38) months (P = 0.152). We define two profiles of liver complications: those emerging earlier (encephalopathy and ascites) and, those occurring continuously during the follow-up (HCC, PHGB) [median (Q1-Q3) time to emergence 12.7 (6.6-28.2) months vs. 25.4 (12.5-41.53) months, respectively (P = 0.026)]. CONCLUSION: The vast majority of HCV-infected patients who develop liver complications after reaching SVR with DAA do it within 3 years after SVR time-point. Specifically, hepatic encephalopathy and ascites do not usually emerge after this period. Conversely, HCC and PHGB may occur in longer term. It is critical to identify patients at risk of developing hepatic events to continue performing surveillance for them.
Filiaciones:
Corma-Gómez A:
Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville
Macías J:
Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville
Téllez F:
Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Faculty of Medicine, Cadiz
Morano L:
Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo
Rivero A:
Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Córdoba
Serrano M:
Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria
Ríos MJ:
Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla
Vera-Méndez FJ:
Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena
Santos M:
Unit of Internal Medicine, Hospital Universitario del SAS de Jerez, Cadiz
Real LM:
Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, Universidad de Málaga
Palacios R:
Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga
Santos IL:
Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid
Geijo P:
Unit of Infectious Diseases, Hospital Virgen de la Luz, Cuenca
Imaz A:
HIV and STI Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona
Merino D:
Unit of Infectious Diseases, Hospital Juan Ramón Jiménez, Huelva
Galindo MJ:
Unit of Infectious Diseases, Hospital Clínico Universitario de Valencia, Valencia
:
Unit of Infectious Diseases, Hospital General Universitario de Alicante, Alicante
López-Ruz MÁ:
Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Granada
Galera C:
Unit of Infectious Diseases, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
Pineda JA:
Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville
Open Access
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