APASL HCV guidelines of virus-eradicated patients by DAA on how to monitor HCC occurrence and HBV reactivation

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Kanda T., Lau G. K. K., Wei L., Moriyama M., Yu M., Chuang W., ...More

HEPATOLOGY INTERNATIONAL, vol.13, no.6, pp.649-661, 2019 (SCI-Expanded, Scopus) identifier

  • Publication Type: Article / Article
  • Volume: 13 Issue: 6
  • Publication Date: 2019
  • Doi Number: 10.1007/s12072-019-09988-7
  • Journal Name: HEPATOLOGY INTERNATIONAL
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.649-661
  • Keywords: HCV, HCC, DAA, SVR, Follow-up, Guideline, HBV, HEPATITIS-B-VIRUS, DIRECT-ACTING ANTIVIRALS, SUSTAINED VIROLOGICAL RESPONSE, CLINICAL-PRACTICE GUIDELINES, GAMMA-CARBOXY PROTHROMBIN, EARLY TUMOR RECURRENCE, SHORT-TERM RISK, HEPATOCELLULAR-CARCINOMA, C VIRUS, ALPHA-FETOPROTEIN
  • Open Archive Collection: AVESIS Open Access Collection
  • Ankara University Affiliated: Yes

Abstract

In the direct-acting antiviral (DAA) era for hepatitis C virus (HCV) infection, sustained virological response (SVR) is very high, but close attention must be paid to the possible occurrence of hepatocellular carcinoma (HCC) and reactivation of hepatitis B virus (HBV) in patients with co-infection who achieved SVR in short term. HCC occurrence was more often observed in patients with previous HCC history. We found occurrence of HCC in 178 (29.6%) of 602 patients with previous HCC history (15.4 months mean follow-up post-DAA initiation) but, in contrast, in only 604 (1.3%) of 45,870 patients without previous HCC history (18.2 months mean follow-up). Thus, in these guidelines, we recommend the following: in patients with previous HCC history, surveillance at 4-month intervals for HCC by ultrasonography (US) and tumor markers should be performed. In patients without previous HCC history, surveillance at 6- to 12-month intervals for HCC including US is recommended until the long-term DAA treatment effects, especially for the resolution of liver fibrosis, are confirmed. This guideline also includes recommendations on how to follow-up patients who have been infected with both HCV and HBV. When HCV was eradicated in these HBsAg-positive patients or patients with previous HBV infection ( anti-HBc and/ or anti-HBs-positive), it was shown that HBV reactivation or HBV DNA reappearance was observed in 67 (41.4%) of 162 or 12 (0.9%) of 1317, respectively. For these co-infected patients, careful attention should be paid to HBV reactivation for 24 weeks post-treatment.