|Title:||APASL HCV guidelines of virus-eradicated patients by DAA on how to monitor HCC occurrence and HBV reactivation||Authors:||Kanda T.
Kadir Dokmeci A.
Mamun-Al-Mahtab, McCaughan G.W.
|Keywords:||DAA; Follow-up; Guideline; HBV; HCC; HCV; SVR||Issue Date:||2019||Publisher:||Springer||Journal Volume:||13||Journal Issue:||6||Start page/Pages:||649-661||Source:||Hepatology International||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. ? 2019, The Author(s).
|ISSN:||1936-0533||DOI:||10.1007/s12072-019-09988-7||SDG/Keyword:||antivirus agent; asunaprevir plus daclatasvir; entecavir; ledipasvir plus sofosbuvir; ribavirin plus sofosbuvir; simeprevir plus sofosbuvir; tenofovir; unclassified drug; antivirus agent; adult; aged; Article; bilirubin blood level; controlled study; disease association; drug efficacy; echography; female; follow up; hepatitis B; hepatitis C; human; liver cell carcinoma; liver fibrosis; major clinical study; male; middle aged; mixed infection; nuclear magnetic resonance imaging; platelet count; practice guideline; priority journal; sustained virologic response; very elderly; viral clearance; virus reactivation; x-ray computed tomography; complication; Hepacivirus; hepatitis B; Hepatitis B virus; hepatitis C; liver cell carcinoma; liver tumor; mixed infection; practice guideline; virology; virus activation; Antiviral Agents; Carcinoma, Hepatocellular; Coinfection; Hepacivirus; Hepatitis B; Hepatitis B virus; Hepatitis C; Humans; Liver Neoplasms; Sustained Virologic Response; Virus Activation
|Appears in Collections:||臨床醫學研究所|
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