Long-term follow-up after cure from chronic hepatitis C virus infection shows occult hepatitis and a risk of hepatocellular carcinoma in noncirrhotic patients

Lybeck, Charlotte; Brenndörfer, Erwin Daniel; Sällberg, Matti; Montgomery, Scott; Aleman, Soo; Duberg, Ann‐Sofi

doi:10.1097/meg.0000000000001316

Cited by 16 publications

(16 citation statements)

References 35 publications

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“…Occult HCV infection is defined by the presence of HCV RNA in liver tissue or peripheral blood mononuclear cells (PBMCs) of patients who test negative for serum HCV RNA, with or without the presence of anti‐HCV antibodies . A few groups reported the presence of occult HCV infection in patients with liver test abnormalities without detectable serum anti‐HCV antibodies and HCV RNA, as well as in patients with spontaneous or treatment‐induced clearance of HCV . Conversely, as we have previously reported, there is a lack of evidence of occult HCV infection after kidney transplantation in patients who had spontaneous HCV clearance or after interferon therapy before transplantation while on dialysis .…”

Section: Introductionmentioning

confidence: 73%

No evidence of occult hepatitis C or E virus infections in liver‐transplant patients with sustained virological response after therapy with direct acting agents

Bello

Abravanel

Alric³

et al. 2019

Transplant Infectious Dis

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Background and Aims: It has been recently suggested that occult hepatitis C virus (HCV) infection and hepatitis E virus (HEV) reactivation might occur after direct acting antiviral agent-induced (DAA-induced) sustained virological response (SVR). The aim of our study was to identify occult HCV and HEV infection in a cohort of organ transplant patients who had achieved SVR and had persistent elevation in liver-enzyme levels. Patients and Method: Sixty-six liver and/or kidney transplant patients were treated with DAAs. All but one achieved SVR12. Twenty-nine (8-39) months post-SVR12, 8 of the 65 patients (12.3%) who achieved SVR12 had persistently elevated liver enzyme levels. In 1 patient, this was related to hepatitis B virus reactivation. In the 7 remaining patients, blood samples (n = 7), liver biopsies (n = 4), and peripheral blood mononuclear cells (PBMCs) (n = 7) were collected simultaneously in order to identify occult HCV or HEV infection.Results: Hepatitis C virus RNA and HEV RNA were not detected in serum, liver tissues, or PBMCs. No HEV reactivation was observed after HCV clearance in patients who had anti-HEV IgG. Conclusion:Our study suggests that there is no occult HCV or HEV infection in transplant patients after successful treatment of HCV infection with DAAs, even in patients with a persistent elevation of liver enzyme levels. However, due to the small number of patients included in our study, this finding should be confirmed in a larger cohort. K E Y W O R D Sdirect acting antiviral agents, hepatitis C virus, hepatitis E virus, kidney transplantation, liver transplantation, occult infection, ribavirin

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Section: Introductionmentioning

confidence: 73%

No evidence of occult hepatitis C or E virus infections in liver‐transplant patients with sustained virological response after therapy with direct acting agents

Bello

Abravanel

Alric³

et al. 2019

Transplant Infectious Dis

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“…Chronic HCV is a major cause of liver fibrosis leading to cirrhosis and hepatocellular carcinoma [23,24]. The rate of progression of fibrosis is highly variable, where progression to cirrhosis ranges from 10 to 30 years [25,26]. The prevalence of chronic HCV infection in Egypt is 14.8% [2], underscoring importance to highlight various parameters associated with fibrosis severity in chronic HCV Egyptian patients.…”

Section: Discussionmentioning

confidence: 99%

Body mass index (BMI) and alpha-fetoprotein (AFP) level correlate with the severity of HCV-induced fibrosis in a cohort of Egyptian patients with chronic HCV

Mohamed¹,

Hemeda²,

Aziz³

et al. 2020

Futur J Pharm Sci

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Background Viral hepatitis is the seventh leading cause of mortality globally, and half of this mortality is attributed to hepatitis C virus (HCV). Egypt has the highest HCV prevalence worldwide, with an estimated 14.7% of the population being HCV-positive. HCV infection is the primary cause of liver fibrosis, cirrhosis, and hepatocellular carcinoma. Liver fibrosis varies in severity during chronic HCV infection, and 10–20% of chronic hepatitis C (CHC) patients with severe fibrosis develop cirrhosis. The goal of this work was to assess the clinico-demographic predictors of severity of HCV-induced fibrosis in a cohort of Egyptian patients. Results A cohort of Egyptian patients with chronic HCV genotype 4a infection showed significant association between severe fibrosis stages and obesity, represented by a higher body mass index (BMI), low albumin level, high alpha-fetoprotein (AFP) level, low thyroid-stimulating hormone (TSH) level, and high alkaline phosphatase (ALP) level. Multivariate analysis delineated BMI, TSH, and ALP as independent significant variables that could predict the risk of fibrosis severity in HCV infections. Conclusion This study argues in favor of using the biomarker profile of CHC patients infected with HCV genotype 4a to identify patients at higher risk of developing severe fibrosis, which is a necessary first step towards precision medicine via patient stratification.

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“…In the current study, the HCC subgroup had a mean AFP value of 313 ± 132 μg/dL and FIB‐4 value 4.2 ± 0.7. Another recent study revealed that an increased risk of HCC could persist in the long term after SVR, even in non‐cirrhotic patients …”

Section: Discussionmentioning

confidence: 99%

Rescue therapy for chronic hepatitis C virus infection after repeated treatment failures: Impact on disease progression and risk of hepatocellular carcinoma

Hanafy

Soliman

2019

Hepatology Research

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Aim: Retreatment after previous failure of direct-acting antivirals for hepatitis C virus (HCV) infection is a challenging decision. The importance of achieving viral eradication on modification of disease progression and outcome, including the risk of hepatocellular carcinoma (HCC), remains a critical issue to be evaluated. Methods:One hundred patients with repeated failure of sofosbuvir and ribavirin or triple therapy with sofosbuvir, ribavirin, and daclatasvir were divided into a study group (n = 50) given rescue therapy (sofosbuvir, daclatasvir, simeprevir, and ribavirin) or a control group (n = 50) matched for age, sex, and pretreatment variables (Child-Turcotte-Pugh score and Fibrosis-4 score). Follow-up was undertaken after the last non-response to detect serious adverse events, such as hepatic decompensation and development of HCC. Results:The study group achieved sustained virologic response (SVR) in 47 of 50 (94%) patients. The control group had significantly higher HCC rates than the study group (7 vs. 1 patients), with an odds ratio of 5.44. The rescue therapy was associated with significantly longer time to the occurrence of adverse events. Repeated treatment failures were associated with progression of FibroScan values in the control group (21 ± 4.5 vs. 10 ± 1.5 kPa, P = 0.001); achieving SVR in the study group stopped fibrosis progression despite non-significant increase from baseline (13.2 ± 3.2 vs. 10.6 ± 0.6, P = 0.12). Conclusions:Rescue treatment for HCV infection was highly effective in achieving SVR, less expensive than the newer agents, and is associated with diminished risk of serious adverse events, mainly HCC in these patients.

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Long-term follow-up after cure from chronic hepatitis C virus infection shows occult hepatitis and a risk of hepatocellular carcinoma in noncirrhotic patients

Abstract: Supplemental Digital Content is available in the text.

Cited by 16 publications

References 35 publications

No evidence of occult hepatitis C or E virus infections in liver‐transplant patients with sustained virological response after therapy with direct acting agents

No evidence of occult hepatitis C or E virus infections in liver‐transplant patients with sustained virological response after therapy with direct acting agents

Body mass index (BMI) and alpha-fetoprotein (AFP) level correlate with the severity of HCV-induced fibrosis in a cohort of Egyptian patients with chronic HCV

Rescue therapy for chronic hepatitis C virus infection after repeated treatment failures: Impact on disease progression and risk of hepatocellular carcinoma

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