Viola Guardigni1, Alice Toschi, Lorenzo Badia, Elena Rosselli Del Turco, Eleonora Salsi, Francesco Cristini, Laura Sighinolfi, Gabriele Fabbri, Marco Massari, Gianluca Cuomo, Pierluigi Viale, Gabriella Verucchi. 1. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy Department of Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, Parma, Italy Infectious Diseases Unit, Rimini-Forlì-Cesena Hospitals, Italy Infectious Diseases Unit, Ferrara Hospital, Italy Infectious Diseases Unit, Ravenna Hospital, Italy Infectious Diseases Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio nell'Emilia, Italy Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.
Abstract
OBJECTIVES: Hepatocellular carcinoma (HCC) has become a major issue in coinfected HIV/HCV patients with liver cirrhosis. We aimed to determine the rate of HCC occurrence after a Direct-Acting Antivirals (DAAs) treatment and to evaluate the factors associated with the risk of HCC in this population. DESIGN: We conducted a retrospective multi-center observational study including cirrhotic HIV/HCV coinfected patients treated with DAAs, between October 2014 and January 2017. METHODS: We collected demographics characteristics, data regarding HIV and HCV infections and treatment with DAAs. We investigated the rate and the time of occurrence of HCC. Statistical analysis explored the factors associated to development of liver cancer. RESULTS: During a median follow-up of 55 months, 24 out of 232 patients developed HCC, after a median of 22.5 months from starting DAAs. Factors associated with HCC were a higher Child-Pugh Turcotte (CPT) score (p 0.002), HCV genotype 3 (p 0.04), previous HCC (p < 0.001) and CD4+ cell count nadir > 350/mm3 (p 0.001), whereas antiretroviral therapy (ART) was associated to a lower rate of cancer (p 0.02). At multivariable analysis CPT score and a history of HCC remained independently associated with HCC after DAAs (p 0.003 and < 0.001, respectively), and ART administration maintained its protective role (p 0.047), regardless of HIV RNA at baseline. CONCLUSIONS: Our study highlights the importance of a long-lasting follow-up for HCC after HCV eradication, mostly in those patients with advanced cirrhosis and history of HCC. Furthermore, our data showed a potential role of ART itself (and not of undetectable HIV RNA) in reducing the risk for HCC development.
OBJECTIVES:Hepatocellular carcinoma (HCC) has become a major issue in coinfected HIV/HCV patients with liver cirrhosis. We aimed to determine the rate of HCC occurrence after a Direct-Acting Antivirals (DAAs) treatment and to evaluate the factors associated with the risk of HCC in this population. DESIGN: We conducted a retrospective multi-center observational study including cirrhotic HIV/HCV coinfectedpatients treated with DAAs, between October 2014 and January 2017. METHODS: We collected demographics characteristics, data regarding HIV and HCV infections and treatment with DAAs. We investigated the rate and the time of occurrence of HCC. Statistical analysis explored the factors associated to development of liver cancer. RESULTS: During a median follow-up of 55 months, 24 out of 232 patients developed HCC, after a median of 22.5 months from starting DAAs. Factors associated with HCC were a higher Child-Pugh Turcotte (CPT) score (p 0.002), HCV genotype 3 (p 0.04), previous HCC (p < 0.001) and CD4+ cell count nadir > 350/mm3 (p 0.001), whereas antiretroviral therapy (ART) was associated to a lower rate of cancer (p 0.02). At multivariable analysis CPT score and a history of HCC remained independently associated with HCC after DAAs (p 0.003 and < 0.001, respectively), and ART administration maintained its protective role (p 0.047), regardless of HIV RNA at baseline. CONCLUSIONS: Our study highlights the importance of a long-lasting follow-up for HCC after HCV eradication, mostly in those patients with advanced cirrhosis and history of HCC. Furthermore, our data showed a potential role of ART itself (and not of undetectable HIV RNA) in reducing the risk for HCC development.