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.

Autor:	Corma-Gómez A; Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville, Spain., Macías J; Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville, Spain., Lacalle-Remigio JR; Division of Preventive Medicine and Public Health, Faculty of Medicine, Universidad de Sevilla, Spain., Téllez F; Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Faculty of Medicine, Cadiz, Spain., Morano L; Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain., Rivero A; Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Córdoba, Spain., Serrano M; Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain., Ríos MJ; Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain., Vera-Méndez FJ; Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain., Alados JC; Unit of Clinical Microbiology, University Hospital Jerez, Cadiz, Spain., Real LM; Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, University of Malaga, Spain., Palacios R; Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain., Santos IL; Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid, Spain., Imatz A; Unit of Infectious Diseases, Hospital Universitario Bellvitge, Barcelona, Spain., Pineda JA; Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville, Spain.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2021 Oct 05; Vol. 73 (7), pp. e2109-e2116.
DOI:	10.1093/cid/ciaa1111
Abstrakt:	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. (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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