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Sustained virological response to direct-acting antiviral regimens reduces the risk of hepatocellular carcinoma in HIV/HCV-coinfected patients with cirrhosis

2018; Oxford University Press; Volume: 73; Issue: 9 Linguagem: Inglês

10.1093/jac/dky234

1460-2091

Nicolás Merchante, Antonio Rivero‐Juárez, Francisco Téllez, Dolores Merino, Maria José Ríos-Villegas, Marina Villalobos, Mohamed Omar, Pilar Rincón, Antonio Rivero, Montserrat Pérez‐Pérez, Miguel Raffo, Inmaculada López-Montesinos, Rosario Palacios, María Amparo Gómez-Vidal, Juan Macı́as, Juan A. Pineda, Nicolás Merchante, Pilar Rincón, Marı́a José Iglesias, Luís Miguel Real, Juan Macı́as, Juan A. Pineda, Antonio Rivero Juárez, Teresa Brieva, Ángela Camacho Espejo, Antonio Rivero, Francisco Téllez, Dolores Merino, Miguel Raffo, Maria José Riós Villegas, Inmaculada López-Montesinos, Marina Villalobos, Rosario Palacios, Jesús Santos, Mohamed Omar, Maria A Gómez Vidal, Monserrat Pérez Pérez,

Liver Disease and Transplantation

To assess the impact of all-oral direct-acting antiviral agent (DAA) regimens on the risk of hepatocellular carcinoma (HCC) in HIV/HCV-coinfected patients with cirrhosis. This was a multicentre prospective cohort study recruiting HIV/HCV-coinfected patients with a new diagnosis of compensated cirrhosis. Patients were followed up until HCC, death or the censoring date (March 2017). The primary endpoint was the emergence of HCC. The incidence rate (IR) (95% CI) of HCC in different groups was computed. Time-to-event analyses were performed to identify predictors of HCC emergence. The study included 495 HIV/HCV-coinfected patients with cirrhosis. After a median (IQR) follow-up of 59 (27–84) months, 22 (4.4%; 95% CI 2.6–6.3) patients developed an HCC. The IR (95% CI) of HCC was 0.93 (0.06–1.42) per 100 person-years (PY). Three hundred and three (61%) patients achieved sustained virological response (SVR) during follow-up, 79 after interferon (IFN)-based regimens and 224 after an all-oral DAA regimen. The IR (95% CI) of HCC after all-oral DAA was 0.35 (0.14–0.85) per 100 PY whereas it was 1.79 (1.11–2.88) per 100 PY in the remaining cohort (P = 0.0005). When only patients with SVR were considered, the IR (95% CI) of HCC after all-oral DAA was 0.32 (0.12–0.86) whereas it was 0 per 100 PY among those with SVR after IFN-based therapies (P = 0.27). Achieving SVR with an all-oral DAA regimen during follow-up was independently associated with a lower risk of HCC emergence (subhazard ratio 0.264; 95% CI 0.070–0.991; P = 0.049). SVR with all-oral DAA regimens reduces the risk of HCC in HIV/HCV-coinfected patients with compensated cirrhosis.