HIV/hepatitis C virus-coinfected patients who achieved sustained virological response are still at risk of developing hepatocellular carcinoma

Merchante, Nicolás; Merino, Esperanza; Rodríguez-Arrondo, Francisco; Tural, Cristina; Muñoz, Josefa; Delgado-Fernández, Marcial; Jover, Federico Blanco; Galindo, Marı́a José; Rivero, Antonio; López‐Aldeguer, José; Aguirrebengoa, Koldo; Romero-Palacios, Alberto; Martínez, Eduardo; Pineda, Juan A.

doi:10.1097/qad.0000000000000005

Cited by 30 publications

(19 citation statements)

References 24 publications

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“…This is in accordance with the relationship between LSM and hepatic venous pressure gradient [20], and with a prospective study including 34 cirrhotic patients with SVR followed over 12 years, in which none developed de novo esophageal varices [18]. In addition, Roberts et al [21] demonstrated that SVR after treatment of compensated Notably, the effect of SVR on the risk of HCC has yielded diverging results [9][10][11]. In HCV monoinfected patients, Poynard et al [22] found four liver cancer in SVR, and 13 in non-SVR, a possibility that should be considered in spite of HCV eradication.…”

Section: Discussionsupporting

confidence: 60%

“…Liver biopsy had been performed in 92 cases (69 %), a median time of 165 days (43-1043) before therapy. All the patients had fibrosis 4, and the median histological activity index (HAI) was 5.84 (4)(5)(6)(7)(8)(9)(10)(11)(12). The remaining 41 patients had a LSM before therapy confirming fibrosis 4.…”

Section: Resultsmentioning

confidence: 97%

“…Berenguer et al [15] showed a risk reduction in death of 97 % after SVR, in comparison with not-treated patients. However, several studies showed a lower but persistent risk of liver-related complications, specifically HCC [9,10]. Thus, to date, there were no data to identify patients who continued in risk, especially in case of cirrhosis.…”

Section: Discussionmentioning

confidence: 93%

“…Cumulative evidence demonstrates that SVR is associated with a lower rate of complications [6][7][8]. However, in spite of a lower risk, patients with cirrhosis are not entirely protected against the risk of liver complications or of developing HCC after SVR [9][10][11]. This fact could be attributed to extensive liver fibrosis or to the persistence of liver cells committed to develop into cancer.…”

Section: Introductionmentioning

confidence: 99%

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Fibrosis Regression Explains Differences in Outcome in HIV-/HCV-Coinfected Patients with Cirrhosis After Sustained Virological Response

et al. 2015

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Section: Discussionsupporting

confidence: 60%

Section: Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Fibrosis Regression Explains Differences in Outcome in HIV-/HCV-Coinfected Patients with Cirrhosis After Sustained Virological Response

et al. 2015

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“…Alcohol has an important influence on tumor development since it acts synergistically in individuals with chronic HBV and/or HCV infection [36] . HIV and HBV or HCV coinfection is an important risk factor, fostering faster liver disease progression than in individuals without HIV; if cirrhosis develops as a result, the risk for HCC is further increased [41] .…”

Section: Risk Factors and Preventionmentioning

confidence: 99%

Diagnosis and treatment of hepatocellular carcinoma: An update

Tejeda-Maldonado¹

2015

WJH

110

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Hepatocellular carcinoma (HCC) is one of the most common malignancies leading to high mortality rates in the general population; in cirrhotic patients, it is the primary cause of death. The diagnosis is usually delayed in spite of at-risk population screening recommendations, i.e., patients infected with hepatitis B or C virus. Hepatocarcinogenesis hinges on a great number of genetic and molecular abnormalities that lead to tumor angiogenesis and foster their dissemination potential. The diagnosis is mainly based on imaging studies such as computed tomography and magnetic resonance, in which lesions present a characteristic classical pattern of early arterial enhancement followed by contrast medium "washout" in late venous phase. On occasion, when imaging studies are not conclusive, biopsy of the lesion must be performed to establish the diagnosis. The Barcelona Clinic Liver Cancer staging method is the most frequently used worldwide and recommended by the international guidelines of HCC management. Currently available treatments include tumor resection, liver transplant, sorafenib and locoregional therapies (alcoholization, radiofrequency ablation, chemoembolization). The prognosis of hepatocarcinoma is determined according to the lesion's stage and in cirrhotic patients, on residual liver function. Curative treatments, such as liver transplant, are sought in patients diagnosed in early stages; patients in more advanced stages, were not greatly benefitted by chemotherapy in terms of survival until the advent of target molecules such as sorafenib. Core tip: This paper reviews the most recent evidence on hepatocarcinoma including its molecular pathogenesis and prognosis, with special emphasis on its diagnosis, staging and treatment. The most recent Easter and Western international guidelines are also reviewed.

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Research gaps in viral hepatitis

2018

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IntroductionThe World Health Organization has aimed for global elimination of both hepatitis B virus (HBV) and hepatitis C virus (HCV) by 2030. Treatments available to cure HCV and control HBV, as well as vaccination to prevent HBV infection, have certainly allowed for such bold goals, yet the final steps to usher in elimination require further evidence.DiscussionWe broadly discuss the needs for three major public health approaches. First, an effective vaccine exists for HBV and mass‐vaccination campaigns have resulted in decreases in hepatitis B surface antigen seroprevalence and overall rates of liver‐related morality. Still, HBV vaccination coverage is poor in certain regions of the world, while the reasons for such low coverage require further study. A prophylactic vaccine is probably needed to eliminate HCV, but is not being readily developed. Second, identifying HBV/HCV infected individuals remains a priority to increase awareness of disease status, particularly for key populations. Research evaluating large‐scale implementation of novel, rapid and mobile point‐of‐care tests would be helpful to determine whether increased awareness is achievable in these settings. Third, antiviral therapy allows for strong HBV suppression and HCV cure, while its access depends on financial factors among many others. Although there is strong evidence to treat key populations and specific groups with progressed disease, as stated in current guidelines, the advantages of extending treatment eligibility to decrease onward spread of HBV/HCV infection and prevent further burden of disease are lacking “real world” evidence. Novel anti‐HBV treatments are being developed to target intrahepatocellular HBV replication, but are still in the early phases of clinical development. Each of the strategies mentioned above has specific implications for HIV infection.ConclusionsThere are certainly effective tools to combat the spread of viral hepatitis and treat infected individuals – yet how they are able to reach key populations, and the infrastructure required to do so, continue to represent the largest research gap when evaluating the progress towards elimination. Continuously adapted and informed research is required to establish the priorities in achieving elimination goals.

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HIV/hepatitis C virus-coinfected patients who achieved sustained virological response are still at risk of developing hepatocellular carcinoma

Cited by 30 publications

References 24 publications

Fibrosis Regression Explains Differences in Outcome in HIV-/HCV-Coinfected Patients with Cirrhosis After Sustained Virological Response

Fibrosis Regression Explains Differences in Outcome in HIV-/HCV-Coinfected Patients with Cirrhosis After Sustained Virological Response

Diagnosis and treatment of hepatocellular carcinoma: An update

Research gaps in viral hepatitis

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