COVID-19 Mid-term Impact on Hepatocellular Carcinoma in Patients With Hepatitis C Chronic Infection

Abstract

Background/Aim: Liver injury has been frequently reported in association with SARS-CoV-2 infection, but data are still lacking regarding the impact of pre-existing liver damage and neoplasia on SARS-CoV-2 infection outcome and vice-versa. This study aimed to assess the effects of SARS-CoV-2 infection on hepatocellular carcinoma (HCC) in chronic hepatitis C virus (HCV) infected patients, both in therapeutic-naïve and patients treated with direct acting antivirals. Patients and Methods: We conducted a retrospective cohort study on 21 patients with a personal history of HCV infection, that have been diagnosed with different forms of HCC and who were subsequently infected with SARS-CoV-2. Patients were monitored by liver function tests, tumoral markers, blood cell count, and coagulation profile periodically. Results: Solitary HCC nodules were predominant among the subjects who achieved sustained virologic response, while multinodular and infiltrative patterns were mostly prevalent among the treatment-naïve group. Most patients had mild and moderate COVID-19 infections. Conclusion: Within the current global pandemicThis article is freely accessible online.

Impact of SARS-CoV-2 Pandemic on the Management of Patients with Hepatocellular Carcinoma

“…Recently, Iavarone et al showed higher 30-day mortality rates in cirrhotic patients with COVID-19 than in those with bacterial infections (34% vs. 17%), as well as when comparing cirrhotic COVID-19 positive patients vs. non cirrhotic ones (34% vs. 18%), especially for those with pulmonary failure and with worsening liver function at COVID-19 diagnosis [ 14 ]. Such a higher risk of serious illness increases also considering the cohort of patients with ongoing liver damage as demonstrated by Guler et al [ 15 ], observing that patients with HCC and active HCV infection show up with severe COVID-19 (such as pneumonia and severe pulmonary disease). Recently, a multicenter international retrospective study including the largest cohort of patients with liver cancer and COVID-19 infection (250 patients before vaccination) described data about mortality rates of HCC patients undergoing different oncological treatments during the first wave of the pandemic (February to December 2020) [ 16 ].…”

Programmed Cell Death Protein 1 Axis Inhibition in Viral Infections: Clinical Data and Therapeutic Opportunities

“…The prevalence of viral hepatitis is higher among patients with malignancies of the liver, gastrointestinal tract, head and neck, and lung and prostate, however, with the specific frequencies dependent upon the type of viral hepatitis. Chronic hepatitis C infection is related to hepatocellular carcinoma (HCC), while eradication of the hepatotropic virus with direct acting antivirals improves survival when HCC patients are infected by other viruses such as COVID-19 [ 142 ]. Only 8% of concomitant malignancy and viral hepatitis cases had their cancer treatment modified because of the viral status of the patients [ 143 ].…”

A spotlight on HCV and SARS-CoV-2 co-infection and brain function

“…Importantly, for HCV and SARS-CoV-2, the degree and nature of their interactions and the underlying mechanisms remain largely unexplored, although the potential for disease modulating effects of HCV infection on COVID-19 outcomes, including long COVID symptoms, is highlighted by evidence discussed in recent reviews ( Devi et al, 2021 ; da Mata et al, 2021 ). For example, one study suggests that among patients with HCV and hepatocellular carcinoma, those with undetectable HCV infection may be at a lower risk of fatality than those with active HCV infection, when diagnosed with SARS-CoV-2 infection ( Guler-Margaritis et al, 2021 ). In a large, retrospective study of individuals with COVID-19 (n = 1193), co-infection with HCV added a cumulative increased risk of mortality to clinical and laboratory predictors of mortality risk, and HCV infection was the only strong predictor of mortality after matching individuals with and without HCV for baseline confounding clinical and laboratory predictors of mortality ( Ronderos et al, 2021 ).…”