Robert Flisiak1, Dorota Zarębska-Michaluk2, Ewa Janczewska3, Tadeusz Łapiński1, Magdalena Rogalska1, Ewa Karpińska4, Tomasz Mikuła5, Beata Bolewska6, Jolanta Białkowska7, Katarzyna Flejscher-Stępniewska8, Krzysztof Tomasiewicz9, Kornelia Karwowska10, Monika Pazgan-Simon11, Anna Piekarska12, Hanna Berak13, Olga Tronina14, Aleksander Garlicki15, Jerzy Jaroszewicz16. 1. Department of Infectious Diseases and Hepatology, Medical University of Bialystok, 15-540 Bialystok, Poland. 2. Department of Infectious Diseases, Jan Kochanowski University, 25-369 Kielce, Poland. 3. Department of Basic Medical Sciences, Faculty of Health Sciences in Bytom, Medical University of Silesia, 41-902 Bytom, Poland. 4. Department of Infectious Diseases, Hepatology and Liver Transplantation, Pomeranian Medical University, 70-204 Szczecin, Poland. 5. Department of Infectious and Tropical Disease and Hepatology, Medical University of Warsaw, 02-091 Warsaw, Poland. 6. Department of Infectious Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland. 7. Department of Infectious and Liver Diseases, Medical University of Lodz, 90-419 Lodz, Poland. 8. Department of Infectious Diseases, Liver Diseases and Immune Deficiencies, Wroclaw Medical University, 50-367 Wroclaw, Poland. 9. Department of Infectious Diseases and Hepatology, Medical University of Lublin, 20-059 Lublin, Poland. 10. Department of Infectious Diseases and Hepatology, Collegium Medicum, Nicolaus Copernicus University, 87-030 Bydgoszcz, Poland. 11. Department of Infectious Diseases and Hepatology, Wroclaw Medical University, 50-367 Wroclaw, Poland. 12. Department of Infectious Diseases and Hepatology, Medical University of Lodz, 90-419 Lodz, Poland. 13. Daily Unit, Hospital of Infectious Diseases in Warsaw, 01-201 Warsaw, Poland. 14. Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland. 15. Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, 31-008 Krakow, Poland. 16. Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-055 Katowice, Poland.
Abstract
(1) Background: Treatment of hepatitis C virus (HCV) infections with direct-acting antivirals (DAA) has demonstrated high efficacy and an excellent safety profile. The cured patients showed a sustained virological response and improved liver function, but also a continued risk of hepatocellular carcinoma (HCC) during the 2-3 years of follow-up after treatment; (2) Methods: A total of 192 patients out of 209 of the primary AMBER study were analyzed five years after treatment with ombitasvir/paritaprevir/ritonavir with or without dasabuvir and with or without ribavirin. Results: We confirmed that HCV clearance after DAA treatment is stable regardless of baseline liver fibrosis. We found that sustained virologic response is associated with a gradual but significant reduction in liver stiffness over 5 years. Liver function improved during the first 2 years of follow-up and remained stable thereafter. The risk of death due to HCC as well as death due to HCV persists through 5 years of follow-up after successful DAA treatment. However, in non-cirrhotic patients, it appears to clear up 3 years after treatment; (3) Conclusions: Monitoring for more than 5 years after curing HCV infection is necessary to assess the long-term risk of possible development of HCC, especially in patients with cirrhosis of the liver.
(1) Background: Treatment of hepatitis C virus (HCV) infections with direct-acting antivirals (DAA) has demonstrated high efficacy and an excellent safety profile. The cured patients showed a sustained virological response and improved liver function, but also a continued risk of hepatocellular carcinoma (HCC) during the 2-3 years of follow-up after treatment; (2) Methods: A total of 192 patients out of 209 of the primary AMBER study were analyzed five years after treatment with ombitasvir/paritaprevir/ritonavir with or without dasabuvir and with or without ribavirin. Results: We confirmed that HCV clearance after DAA treatment is stable regardless of baseline liver fibrosis. We found that sustained virologic response is associated with a gradual but significant reduction in liver stiffness over 5 years. Liver function improved during the first 2 years of follow-up and remained stable thereafter. The risk of death due to HCC as well as death due to HCV persists through 5 years of follow-up after successful DAA treatment. However, in non-cirrhotic patients, it appears to clear up 3 years after treatment; (3) Conclusions: Monitoring for more than 5 years after curing HCV infection is necessary to assess the long-term risk of possible development of HCC, especially in patients with cirrhosis of the liver.
Authors: Paweł Pabjan; Michał Brzdęk; Magdalena Chrapek; Kacper Dziedzic; Krystyna Dobrowolska; Katarzyna Paluch; Anna Garbat; Piotr Błoniarczyk; Katarzyna Reczko; Piotr Stępień; Dorota Zarębska-Michaluk Journal: Viruses Date: 2022-01-06 Impact factor: 5.048