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Hepatocellular carcinoma after sustained virological response with interferon-free regimens in HIV/hepatitis C virus-coinfected patients

Merchante, Nicolása; Rodríguez-Arrondo, Franciscob; Revollo, Borisc; Merino, Esperanzad; Ibarra, Sofíae; Galindo, María J.f; Montero, Martag; García-Deltoro, Miguelh; Rivero-Juárez, Antonioi; Téllez, Franciscoj; Delgado-Fernández, Marcialk; Ríos-Villegas, María J.l; García, María A.m; Vera-Méndez, Francisco J.n; Ojeda-Burgos, Guillermoo; López-Ruz, Miguel A.p; Metola, Luisq; Omar, Mohamedr; Alemán-Valls, María Remedioss; Aguirrebengoa, Koldot; Portu, Josebau; Raffo, Miguelv; Macías, Juana; Pineda, Juan A.a on behalf of the GEHEP-002 Study Group

doi: 10.1097/QAD.0000000000001809
CLINICAL SCIENCE
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Objective: To assess the possible association between the use of direct antiviral agents (DAA) and the risk of hepatocellular carcinoma (HCC) in HIV/hepatitis C virus (HCV)-coinfected patients.

Methods: The GEHEP-002 cohort recruits HCC cases in HIV-infected patients from 32 centers from Spain. Three analyses were performed: the proportion of HCC cases after sustained virological response (SVR) and the evolution of this proportion over time, the frequency of HCC after SVR in HIV/HCV-coinfected patients with cirrhosis, and the probability of HCC recurrence after curative therapies among those undergoing HCV therapy.

Results: Forty-two (13%) out of 322 HCC cases in HIV/HCV-coinfected patients occurred after SVR. Twenty-eight (10%) out of 279 HCC cases diagnosed during the years of use of IFN-based regimens occurred after SVR whereas this occurred in 14 (32.6%) out of the 43 HCC cases diagnosed in the all-oral DAA period (P < 0.0001). One thousand, three hundred and thirty-seven HIV/HCV-coinfected patients with cirrhosis achieved SVR in the cohort. The frequency of HCC after SVR declined from 15% among those cured with pegylated-IFN with ribavirin to 1.62 and 0.87% among those cured with DAA with and without IFN, respectively. In patients with previous HCC treated with curative therapies, HCC recurrence occurred in two (25%) out of eight patients treated with IFN-based regimens and four (21%) out of 19 treated with DAA-IFN-free regimens (P = 1.0).

Conclusion: The frequency of HCC emergence after SVR has not increased after widespread use of DAA in HIV/HCV-coinfected patients. DAA do not seem to impact on HCC recurrence in the short-term among those with previously treated HCC.

aUnidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla

bHospital Universitario de Donostia, San Sebastián

cHospital German Trias i Pujol, Badalona

dHospital General Universitario de Alicante, Alicante

eHospital de Basurto, Bilbao

fHospital Clínico Universitario de Valencia

gHospital Universitario y Politécnico La Fe

hHospital General de Valencia, Valencia

iInstituto Maiomónides de Investigación Biomédica de Córdoba (IMIBIC). Hospital Universitario Reina Sofía, Córdoba

jHospital Universitario de Puerto Real. Hospital de La Línea. Instituto de Investigación e Innovación en Ciencias Biomédicas de la provincia de Cádiz (INiBICA), Cádiz

kHospital Regional Universitario de Málaga, Málaga

lHospital Universitario Virgen Macarena, Sevilla

mHospital de Galdakao, Galdakao

nHospital General Universitario de Santa Lucía, Cartagena

oHospital Virgen de la Victoria, Málaga

pHospital Universitario Virgen de las Nieves, Granada

qHospital de San Pedro, Logroño

rComplejo Hospitalario de Jaén, Jaén

sHospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife

tHospital de Cruces, Bilbao

uHospital Txagorritxu, Vitoria

vComplejo Hospitalario de Huelva, Huelva, Spain.

Correspondence to Nicolás Merchante, PhD, MD, Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avenida de Bellavista s/n, 41014 Sevilla, Spain. Tel: +34 955015684/34 955015757; fax: +34 955015757; e-mail: nicolasmerchante@gmail.com

Received 22 June, 2017

Revised 8 October, 2017

Accepted 16 October, 2017

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