Human Immunodeficiency Virus (HIV) Infection Is Associated With Lower Risk of Hepatocellular Carcinoma After Sustained Virological Response to Direct-acting Antivirals in Hepatitis C Infected Patients With Advanced Fibrosis

  1. Lacalle-Remigio, Juan Ramón 1
  2. Geijo, Paloma
  3. Javier Reus Bañuls, Sergio
  4. Corma-Gómez, Anaïs 2
  5. Galera, Carlos
  6. Pineda, Juan Antonio 2
  7. Morano, Luis 3
  8. Rivero, Antonio 4
  9. Ángel López-Ruz, Miguel
  10. Ríos, María José 5
  11. Jose Galindo, Maria
  12. Serrano, Miriam 6
  13. Merino, Dolores
  14. Macías, Juan 2
  15. Alados, Juan Carlos 7
  16. Pérez Camacho, Inés
  17. Palacios, Rosario 8
  19. Imatz, Arkaitz 9
  20. Vera-Méndez, Francisco Jesús 10
  21. Téllez, Francisco 11
  22. Real, Luis Miguel 12
  23. Santos, Ignacio De Los 13
  1. 1 Division of Preventive Medicine and Public Health, Faculty of Medicine, Universidad de Sevilla, Spain
  2. 2 Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville, Spain
  3. 3 Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
  4. 4 Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Córdoba, Spain
  5. 5 Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain
  6. 6 Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
  7. 7 Unit of Clinical Microbiology, University Hospital Jerez, Cadiz, Spain
  8. 8 Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain
  9. 9 Unit of Infectious Diseases, Hospital Universitario Bellvitge, Barcelona, Spain
  10. 10 Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain
  11. 11 Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Faculty of Medicine, Cadiz, Spain
  12. 12 Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, University of Malaga, Spain
  13. 13 Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid, Spain
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Revista:
Clinical Infectious Diseases

ISSN: 1058-4838,  1537-6591

Año de publicación: 2020

Tipo: Artículo

DOI: 10.1093/CID/CIAA1111 GOOGLE SCHOLAR

Otras publicaciones en: Clinical Infectious Diseases

Resumen

Abstract Background The aim of this study was to assess the impact of human immunodeficiency virus (HIV) infection on the risk of developing hepatocellular carcinoma (HCC) in patients infected with hepatitis C virus (HCV) who achieve sustained virological response (SVR) with direct-acting antiviral (DAA). Methods Multisite prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they met: (1) SVR with DAA-based combination; (2) liver stiffness (LS) ≥9.5 kPa previous to treatment; (3) LS measurement at the SVR time-point. The main endpoint was the occurrence of HCC. Propensity score (PS) was calculated to address potential confounders due to unbalanced distribution of baseline characteristics of HIV/HCV-coinfected and HCV-monoinfected patients. Results In total, 1035 HCV-infected patients were included, 667 (64%) coinfected with HIV. After a median (Q1–Q3) follow-up time of 43 (31–49) months, 19 (1.8%) patients developed HCC (11 [3.0%]; HCV-monoinfected, 8[1.2%]; HIV/HCV-coinfected individuals; P = .013). In the multivariable analysis, HIV coinfection was associated with a lower adjusted risk of developing HCC (subhazard ratio [sHR] = 0.27, 95% confidence interval [CI]: .08–.90; P = .034). Predictors of HCC emergence were: HCV genotype 3 (sHR = 7.9, 95% CI: 2.5–24.9; P < .001), MELD score at SVR >10 (sHR = 1.37, 95% CI: 1.01–1.86; P = .043) and LS value at SVR (sHR = 1.03, 95% CI: 1.01–1.06, for 1 kPa increase; P = .011). Using inverse probability weighting method on the PS, HIV-infected patients had a lower risk of HCC (powered HR = 0.33, 95% CI: .11–.85). Conclusions Among HCV-infected patients with advanced fibrosis, who achieve SVR with DAA, HIV coinfection seems to be associated with a lower risk of HCC occurrence. The underlying causes for this finding need to be investigated.

Referencias bibliográficas

  • Macías, (2009), Hepatology, 50, pp. 1056, 10.1002/hep.23136
  • Klein, (2016), Clin Infect Dis, 63, pp. 1160
  • Re, (2014), Ann Intern Med, pp. 369
  • Pineda, (2005), Hepatology, 41, pp. 779, 10.1002/hep.20626
  • Lledó, (2018), AIDS, 32, pp. 2347, 10.1097/QAD.0000000000001966
  • Malin, (2019), HIV Med, 20, pp. 230, 10.1111/hiv.12705
  • Rial-Crestelo, (2019), AIDS
  • Nahon, (2017), Gastroenterology, 152, pp. 142, 10.1053/j.gastro.2016.09.009
  • Bang, (2017), BMC Gastroenterol, 17, pp. 46, 10.1186/s12876-017-0606-9
  • Merchante, (2018), J Antimicrob Chemother, 73, pp. 2435, 10.1093/jac/dky234
  • Backus, (2019), Hepatology, 69, pp. 487, 10.1002/hep.29408
  • Carrat, (2019), Lancet, 393, pp. 1453, 10.1016/S0140-6736(18)32111-1
  • Calvaruso, (2018), Gastroenterology, 155, pp. 411, 10.1053/j.gastro.2018.04.008
  • Ioannou, (2018), J Hepatol, 68, pp. 25, 10.1016/j.jhep.2017.08.030
  • van der Meer, (2017), J Hepatol, 66, pp. 485, 10.1016/j.jhep.2016.10.017
  • Kanwal, (2020), Hepatology, 71, pp. 44, 10.1002/hep.30823
  • Salmon-Ceron, (2019), Hepatology, 70, pp. 939, 10.1002/hep.30400
  • Corma-Gómez, (2019), AIDS, 33, pp. 1167, 10.1097/QAD.0000000000002186
  • Merchante, (2012), Hepatology, 56, pp. 228, 10.1002/hep.25616
  • Corma-Gómez, (2019), Clin Infect Dis, 10.1093/cid/ciz1140
  • Merchante, (2017), AIDS, 31, pp. 493, 10.1097/QAD.0000000000001358
  • Marrero, (2018), Hepatology, 68, pp. 723, 10.1002/hep.29913
  • Pineda, (2007), Hepatology, 46, pp. 622, 10.1002/hep.21757
  • Agüero, (2016), Hepatology, 63, pp. 488, 10.1002/hep.28321
  • van der Wal, (2011), J Stat Softw, 43, pp. 2
  • Ho, (2011), J Stat Softw, 42, pp. 1, 10.18637/jss.v042.i08
  • Choi, (2019), JAMA Oncol, 5, pp. 30, 10.1001/jamaoncol.2018.4070
  • Yip, (2019), Gastroenterology, 158, pp. 215, 10.1053/j.gastro.2019.09.025
  • Kim, (2019), J Hepatol, 71, pp. 456, 10.1016/j.jhep.2019.03.028
  • Murata, (2018), Gut, 67, pp. 362, 10.1136/gutjnl-2016-312653
  • Abushahba, (2010), Cancer Immunol Immunother, 59, pp. 1059, 10.1007/s00262-010-0831-3
  • Hamdane, (2019), Gastroenterology, 156, pp. 2313, 10.1053/j.gastro.2019.02.038
  • Olivero, (2007), Environ Mol Mutagen, 48, pp. 215, 10.1002/em.20195
  • Martí-Rodrigo, (2020), Gut, 69, pp. 920, 10.1136/gutjnl-2019-318372