Predicting Hepatocellular Carcinoma Risk in Patients with Chronic HCV Infection and a Sustained Virological Response to Direct-Acting Antivirals

Direct-acting antivirals with or without peginterferon α (PEG-IFN α) plus ribavirin are now available for the treatment of hepatitis C virus (HCV) infection. Direct-acting antivirals are potent inhibitors of HCV replication, but some of them occasionally possess serious adverse events. We experienced a 64-year-old female with chronic HCV genotype 1b infection who showed elevated alanine aminotransferase of 528 IU/l at week 9 after the commencement of treatment of simeprevir with PEG-IFN α-2a plus ribavirin. However, she achieved sustained virological response at week 24 after the end of treatment. In Japan, we also have to treat elderly patients infected with HCV and/or advanced hepatic fibrosis. Until an effective interferon-free regimen is established, direct-acting antivirals with PEG-IFN plus ribavirin may still play a role in the treatment for certain patients. To avoid serious results from adverse events, careful attention and follow-up will be needed in the treatment course of simeprevir with PEG-IFN plus ribavirin for chronic HCV infection.

Download Full-text

Hepatocellular carcinoma risk in hepatitis C stage‐3 fibrosis after sustained virological response with direct‐acting antivirals

Liver International ◽

10.1111/liv.15032 ◽

2021 ◽

Author(s):

María Sánchez‐Azofra ◽

Inmaculada Fernández ◽

María L. García‐Buey ◽

Lourdes Domínguez‐Domínguez ◽

Conrado M. Fernández‐Rodríguez ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis C ◽

Sustained Virological Response ◽

Virological Response ◽

Direct Acting Antivirals ◽

Direct Acting ◽

Carcinoma Risk

Download Full-text

Study of Adverse Drug Effects of Direct-Acting Antivirals for Chronic HCV Infection at Fayoum Governorate, Egypt - A Pharmacovigilance Study

Current Drug Safety ◽

10.2174/1574886313666180716111529 ◽

2018 ◽

Vol 13 (3) ◽

pp. 187-195 ◽

Cited By ~ 1

Author(s):

Eman I. Ahmed ◽

Wafaa Y. Abdel Wahed ◽

Essam A. Hassan ◽

Tarek I. Ahmed

Keyword(s):

Drug Effects ◽

Hcv Infection ◽

Adverse Drug Effects ◽

Direct Acting Antivirals ◽

Chronic Hcv Infection ◽

Chronic Hcv ◽

Direct Acting ◽

Fayoum Governorate

Download Full-text

When Coadministration Cannot Be Avoided: Real World Experience of Direct Acting Antivirals for the Treatment of Hepatitis C Virus Infection in Patients on First Generation Anticonvulsants

Journal of Pharmacy Practice ◽

10.1177/0897190020977762 ◽

2020 ◽

pp. 089719002097776

Author(s):

Kayla M. Natali ◽

Humberto R. Jimenez ◽

Jihad Slim

Keyword(s):

Drug Interaction ◽

Hepatitis C ◽

Clinical Cure ◽

First Generation ◽

Virologic Response ◽

Hcv Infection ◽

Direct Acting Antivirals ◽

Chronic Hcv Infection ◽

Chronic Hcv ◽

Direct Acting

Background Coadministration of direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection and first generation anticonvulsants is currently not recommended due to a drug-drug interaction that could potentially lead to subtherapeutic DAA levels and subsequent treatment failure. Currently, there is limited data evaluating this interaction and timely treatment of HCV infection with DAAs is imperative to prevent liver-related morbidity and mortality. Methods A retrospective case series evaluating clinical cure of chronic HCV infection, defined as sustained virologic response (SVR) 12 weeks after completion of DAA therapy, in patients from three inner-city clinics who remained on first generation anticonvulsants during the treatment course. Results A total of five patients received standard dose DAAs for treatment of chronic HCV infection while being maintained on first generation anticonvulsants. The most common HCV genotype was 1a (80%), followed by 1b (20%). The majority of patients were treated with glecaprevir/pibrentasvir (80%) for eight weeks and one patient was treated with ledipasvir/sofosbuvir for 12 weeks. Anticonvulsant regimens consisted of carbamazepine, phenytoin, phenytoin plus phenobarbital, phenytoin plus levetiracetam, and phenobarbital plus lacosamide. All five patients achieved sustained virologic response (SVR) despite this drug-drug interaction. Conclusion Although every effort to prevent concomitant use of DAAs and potent inducers should be made, clinical cure may still be achieved in patients whom cannot avoid this coadministration.

Download Full-text

New direct-acting antivirals for patients with chronic HCV infection: can we monitor treatment using an HCV core antigen assay?

Diagnostic Microbiology and Infectious Disease ◽

10.1016/j.diagmicrobio.2016.11.010 ◽

2017 ◽

Vol 87 (3) ◽

pp. 243-246 ◽

Cited By ~ 7

Author(s):

R. Alonso ◽

F. Pérez-García ◽

D. Ampuero ◽

E. Reigadas ◽

E. Bouza

Keyword(s):

Hcv Infection ◽

Core Antigen ◽

Direct Acting Antivirals ◽

Hcv Core Antigen ◽

Antigen Assay ◽

Chronic Hcv Infection ◽

Chronic Hcv ◽

Direct Acting

Download Full-text

French hepatitis C care cascade: substantial impact of direct-acting antivirals, but the road to elimination is still long

BMC Infectious Diseases ◽

10.1186/s12879-020-05478-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Cécile Brouard ◽

Josiane Pillonel ◽

Marjorie Boussac ◽

Victor de Lédinghen ◽

Antoine Rachas ◽

...

Keyword(s):

Hepatitis C ◽

Antiviral Treatment ◽

Hcv Infection ◽

World Health ◽

Direct Acting Antivirals ◽

Substantial Impact ◽

Chronic Hcv Infection ◽

Chronic Hcv ◽

Direct Acting ◽

The Impact

Abstract Background Hepatitis C virus (HCV) elimination by 2030, as targeted by the World Health Organization (WHO), requires that 90% of people with chronic infection be diagnosed and 80% treated. We estimated the cascade of care (CoC) for chronic HCV infection in mainland France in 2011 and 2016, before and after the introduction of direct-acting antivirals (DAAs). Methods The numbers of people (1) with chronic HCV infection, (2) aware of their infection, (3) receiving care for HCV and (4) on antiviral treatment, were estimated for 2011 and 2016. Estimates for 1) and 2) were based on modelling studies for 2011 and on a virological sub-study nested in a national cross-sectional survey among the general population for 2016. Estimates for 3) and 4) were made using the National Health Data System. Results Between 2011 and 2016, the number of people with chronic HCV infection decreased by 31%, from 192,700 (95% Credibility interval: 150,900-246,100) to 133,500 (95% Confidence interval: 56,900-312,600). The proportion of people aware of their infection rose from 57.7 to 80.6%. The number of people receiving care for HCV increased by 22.5% (representing 25.7% of those infected in 2016), while the number of people on treatment increased by 24.6% (representing 12.1% of those infected in 2016). Conclusions This study suggests that DAAs substantially impact CoC. However, access to care and treatment for infected people remained insufficient in 2016. Updating CoC estimates will help to assess the impact of new measures implemented since 2016 as part of the goal to eliminate HCV.

Download Full-text

SAT-229-Risk of hepatocellular carcinoma in patients with chronic hepatitis C and stage-3 liver fibrosis after sustained virological response with direct acting antivirals

Journal of Hepatology ◽

10.1016/s0618-8278(19)31462-8 ◽

2019 ◽

Vol 70 (1) ◽

pp. e731 ◽

Cited By ~ 3

Author(s):

Maria Sanchez-Azofra ◽

Inmaculada Fernández Vázquez ◽

Maria Luisa Garcia ◽

Lourdes Dominguez ◽

Conrado Fernández-Rodríguez ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Chronic Hepatitis ◽

Hepatitis C ◽

Liver Fibrosis ◽

Sustained Virological Response ◽

Chronic Hepatitis C ◽

Virological Response ◽

Direct Acting Antivirals ◽

Direct Acting

Download Full-text

Hepatic resection for two giant hepatocellular carcinoma after oral direct-acting antiviral therapy: Is there a relationship?

Journal of Solid Tumors ◽

10.5430/jst.v8n2p32 ◽

2018 ◽

Vol 8 (2) ◽

pp. 32 ◽

Cited By ~ 1

Author(s):

Mohamed Abdel Wahab ◽

Ahmed Shehta ◽

Mahmoud Ali

Keyword(s):

Hepatocellular Carcinoma ◽

Antiviral Drugs ◽

Hcv Infection ◽

Dramatic Improvement ◽

Direct Acting Antiviral ◽

Increased Risk ◽

Chronic Hcv Infection ◽

Chronic Hcv ◽

Direct Acting ◽

The Relationship

Introduction: Direct-acting antiviral drugs have been recently introduced for management of chronic hepatitis C virus (HCV) patients. Those medications have achieved a dramatic improvement of sustained virologic response (SVR) reaching almost 90%. However, reports regarding the increased risk of occurrence or recurrence of hepatocellular carcinoma (HCC) in chronic HCV patients who achieved SVR after direct-acting antiviral drugs are controversial.Methods: We report two cases of giant HCCs complicating chronic HCV infection after direct-acting antiviral drugs-based therapies and were managed by major hepatic resection.Results: Two male patients with chronic HCV infection received several regimens oral direct acting antiviral drugs with a SVR for 3 and 6 months, respectively. They complained of progressive right hypochondrial pain and abdominal enlargement. Two large HCCs were diagnosed (16.2 cm * 17.6 cm * 16.9 cm, and 18 cm * 13 cm * 16.5 cm in dimensions) with markedly elevated serum alpha feto-protein (36,000 and 7,000 ng/ml, respectively). Due to the presence of adequate residual liver volume, the decision was to proceed for surgical resection. Central hepatectomy and extended right hemi-hepatectomy were performed, respectively. Patients had smooth postoperative course and were discharged after 10 and 9 days, respectively.Conclusion: The relationship between direct-acting antiviral drugs and HCC is controversial. Those cases add support to the accumulating literature suggesting the relationship of HCC development in chronic HCV patients receiving direct-acting antiviral drugs. Further prospective studies with adequate long term follow up are needed to prove or disprove this relationship.

Download Full-text