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

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 w...

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Published in:Hepatology international 2019-11, Vol.13 (6), p.649-661
Main Authors: Kanda, Tatsuo, Lau, George K. K., Wei, Lai, Moriyama, Mitsuhiko, Yu, Ming-Lung, Chuang, Wang-Long, Ibrahim, Alaaeldin, Lesmana, Cosmas Rinaldi Adithya, Sollano, Jose, Kumar, Manoj, Jindal, Ankur, Sharma, Barjesh Chander, Hamid, Saeed S., Kadir Dokmeci, A., Mamun-Al-Mahtab, McCaughan, Geoffrey W., Wasim, Jafri, Crawford, Darrell H. G., Kao, Jia-Horng, Ooka, Yoshihiko, Yokosuka, Osamu, Sarin, Shiv Kumar, Omata, Masao
Format: Article
Language:English
Subjects:
Activation
Antiviral Agents - therapeutic use
Carcinoma, Hepatocellular - etiology
Carcinoma, Hepatocellular - prevention & control
Carcinoma, Hepatocellular - virology
Coinfection
Colorectal Surgery
Deoxyribonucleic acid
DNA
Fibrosis
Guidelines
Hepacivirus
Hepatitis
Hepatitis B
Hepatitis B - complications
Hepatitis B - drug therapy
Hepatitis B surface antigen
Hepatitis B virus
Hepatitis C
Hepatitis C - complications
Hepatitis C - drug therapy
Hepatocellular carcinoma
Hepatology
Humans
Infections
Intervals
Liver cancer
Liver Neoplasms - etiology
Liver Neoplasms - prevention & control
Liver Neoplasms - virology
Medicine
Medicine & Public Health
Surgery
Surveillance
Sustained Virologic Response
Tumor markers
Ultrasound
Virus Activation
Viruses
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Summary: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.
ISSN:1936-0533
1936-0541
DOI:10.1007/s12072-019-09988-7