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.
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.
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).
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: firstname.lastname@example.org
Received 22 June, 2017
Revised 8 October, 2017
Accepted 16 October, 2017
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