Background In the setting of HCV active infection, liver stiffness (LS)-based strategies identify patients with low risk of developing esophageal variceal bleeding (VB) episodes, in whom unnecessary upper esophagogastroduodenoscopy (UGE) screening can safely avoided. However, after sustained virological response (SVR), data on the accuracy of the criteria predictingthis outcomein HCV-infected patients with cirrhosis, with or without HIV-coinfection, are very limited. Methods Multicenter prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if: 1) SVR with DAA-based therapy; 2) LS ≥9.5 kPa previous to treatment; 3) LS measurement at the SVR time-point≥ 14kPa. Diagnostic accuracy of HEPAVIR, expanded Baveno VI and HIV cirrhosis criteria, at the time of SVR, wasevaluated. Missed VB episodes, negative predictive values (NPV), and number of spared UGEs were specifically assessed. Results 435patients were included, 284 (65%) coinfected with HIV. Seven(1.6%) patients developed a firstepisode of VB after SVR. In patients without a previous VB episode, HEPAVIR, expanded Baveno VI and HIV cirrhosis criteria achieved NPV for first VB episode after SVR of 99.5% (97.1%-100%), 100% (97.8%-100%) and 100% (98%-100%) while sparing 45%, 39% and 44% of UGEs, respectively. When considering HIV-coinfection, the performance of the three criteria was similar, both in HCV-monoinfected and HIV/HCV-coinfected individuals. Conclusions After SVR, predictive LS-based strategies accurately identify HCV-infected patients, HIV-coinfected or not, with low risk of developing VB during follow-up. In these specific patients, using HIV cirrhosis criteria maximize the number of spared UGEs while missing no VB episode.

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) a

Background The aim of this study was to assess the impact of HIV infection on the risk of developing hepatocellular carcinoma (HCC) in HCV-infected patients who achieve sustained virological response (SVR) with direct-acting antiviral (DAA). Methods Multisite prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they met: 1) SVR with DAA-based combination; 2) Liver stiffness (LS) ≥9.5 kPa previous to treatment; 3) LS measurement at the SVR time-point. The main endpoint was the occurrence of HCC. Propensity score (PS) was calculated to address potential confounders due to unbalanced distribution of baseline characteristics of HIV/HCV-coinfected and HCV-monoinfected patients. Results 1035 HCV-infected patients were included, 667 (64%) coinfected with HIV. After a median (Q1-Q3) follow-up time of 43 (31-49) months, 19 (1.8%) patients developed HCC [11 (3.0%) HCV-monoinfected, 8(1.2%) HIV/HCV-coinfected individuals; p=0.013]. In the multivariable analysis, HIV co-infection was associated with a lower adjusted risk of developing HCC [sHR=0.27, 95% IC (0.08-0.90); p=0.034]. Predictors of HCC emergence were: HCV genotype 3 [sHR=7.9 (2.5-24.9); p<0.001], MELD score at SVR>10 [sHR=1.37 (1.01-1.86); p=0.043] and LS value at SVR [sHR=1.03 (1.01-1.06) for 1 kPa increase; p=0.011]. Using inverse probability weighting method on the PS, HIV-infected patients had a lower risk of HCC [powered HR=0.33 (0.11-0.85)]. Conclusions Among HCV-infected patients with advanced fibrosis, who achieve SVR with DAA, HIV-coinfection seems to be associated with a lower risk of HCC occurrence. The underlying causes for this finding need to be investigated.

TW4-response indicates the probability of achieving SVR to currently used DAA-based therapy in HCV genotype 3-infected individuals with cirrhosis. This finding may be useful to tailor treatment strategy in this setting.

BackgroundPegylated Interferon-alpha-2b (pegIFNα2b) is an effective agent for the treatment of haematological malignancies. As it does not inhibit DNA synthesis, this agent may be safe for use during pregnancy.PurposeTo describe 2 cases of successful pregnancies in patients with haematological disorders treated with pegIFNα2b.Material and methodsMedical record review and literature search.ResultsPatient 1: 30-year-old woman diagnosed with polycythaemia vera at age 13, well-controlled with hydroxyurea. Chemotherapy was interrupted due to the patient’s desire for a second pregnancy and treatment with pegIFNα2b 50mcg/week subcutaneously was initiated. (During the first pregnancy she received non-pegylated-IFNα2b with good progression but low tolerance due to influenza-like symptoms). 5 months later, she became pregnant, but was hospitalised due to headaches which caused a dose reduction to 30 mcg/week of pegIFNα2b. Finally, the patient delivered a healthy male infant. 15 days later, pegIFNα2b treatment was interrupted to recommence the usual treatment with hydroxyurea.Patient 2: 27-year-old woman with Philadelphia chromosome-positive chronic myeloid leukaemia diagnosed at age 22, well-controlled with imatinib. The patient interrupted antineoplastic treatment due to her desire to conceive a child and subcutaneous treatment with pegIFNα2b at 50 mcg/week was initiated. She became pregnant after 4 months and pegIFNα2b dose was increased to 80 mcg/week and developed hypothyroidism which was treated with levothyroxine. Finally, the patient delivered a healthy male infant and 1 month later, she discontinued pegIFNα2b and levothyroxine treatment to recommence her usual treatment with imatinib.Both were normal full-term deliveries. Infant growth and development have been normal to date (follow-up time of 2 and 3 years). Blood tests were normal during pregnancies. Only mild anaemia and slight neutrophilia were detected in the first patient, but did not require treatment interruption.ConclusionPegIFNα2b was well tolerated, safe and effective, and caused no complications during the pregnancies. Since chemotherapy agents involve teratogenic effects, pegIFNα2b might be a safe treatment option during pregnancy, although further teratogenic studies are necessary.References and/or acknowledgementsNo conflict of interest.