1
|
Li M, Li Y, Zhang Y, Wang X, Lin C. Five-year follow-up of sustained virological response with hepatitis C infection after direct-acting antiviral therapy: A single-center retrospective study. Medicine (Baltimore) 2024; 103:e37212. [PMID: 38363923 PMCID: PMC10869073 DOI: 10.1097/md.0000000000037212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/18/2024] [Indexed: 02/18/2024] Open
Abstract
In recent years, direct-acting antivirals (DAAs) have dramatically improved the sustained virological response (SVR) rates in chronic hepatitis C (CHC) patients with their favorable safety and efficacy. However, there is a lack of data on the long-term prognosis of DAA therapy for CHC patients after achieving SVR in the real world. The aim of this study was to evaluate the long-term clinical prognosis of patients with chronic hepatitis C treated by DAA after achieving SVR. This study was a single-center, retrospective, observational study that included 243 CHC patients who reached SVR after DAA treatment in the Third Affiliated Hospital of Sun Yat-sen University from January 2017 to December 2021, with a median follow-up period (FUP) of 24 months, to assess the long-term prognosis and clinical outcomes of CHC patients who reached SVR by DAA treatment. A total of 243 patients were enrolled in this study, 151 patients were male, the mean age of this study was 46.7 ± 12.3 years old, and 23.0% (n = 56) patients were cirrhosis in the baseline. At the end of follow-up, 9 patients (3.7%) progressed to hepatocellular carcinoma (HCC), and patients with cirrhosis at baseline (n = 5) had a significantly higher risk of HCC compared with noncirrhotic patients (n = 4; OR = 4.485, 95% CI: 1.162-17.318, P = .029); 2.9% patients (n = 7) relapsed at the median FUP of 12 months, and patients with genotype 3b had a significantly higher risk of relapsing than those without genotype 3b (OR = 18.48, P = .002, 95% CI: 2.866-119.169). ALT, AST, and ALB all showed improvement at the end of treatment compared with the baseline, remaining at normal levels during FUP meanwhile. The DAA-induced SVR was durable, with conspicuous improvement in clinical outcomes. Nevertheless, patients, especially patients with cirrhosis, still exist the risk of appearance of HCC after reaching SVR. Therefore, regular surveillance and monitoring is necessary even after patients reached SVR.
Collapse
Affiliation(s)
- Mengyue Li
- Department of Infectious diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yiting Li
- Department of Infectious diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying Zhang
- Department of Infectious diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiangyang Wang
- GuangZhou International Travel Health Care Center, Guangzhou, China
| | - Chaoshuang Lin
- Department of Infectious diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
2
|
Clark PJ, Valery PC, Strasser SI, Weltman M, Thompson AJ, Levy M, Leggett B, Zekry A, Rong J, Angus P, George J, Bollipo S, McGarity B, Sievert W, Macquillan G, Tse E, Nicoll A, Wade A, Chu G, Harding D, Cheng W, Farrell G, Roberts SK. Liver Disease and Poor Adherence Limit Hepatitis C Cure: A Real-World Australian Treatment Cohort. Dig Dis Sci 2023; 68:291-303. [PMID: 35552941 PMCID: PMC9883319 DOI: 10.1007/s10620-022-07483-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS In 2016, direct-acting antiviral (DAA) treatment for hepatitis C (HCV) became available through Australia's universal health care system, with the aim of HCV elimination. We report real-world effectiveness of DAA HCV treatment in Australia from a clinically well-informed cohort, enriched for cirrhosis and prior HCV treatment. METHODS 3413 patients were recruited from 26 hospital liver clinics across Australia from February 2016 to June 2020. Clinical history and sustained viral response (SVR) were obtained from medical records and data linkage to the Australian Pharmaceutical Benefits Scheme. Factors associated with SVR were assessed by multivariable logistic regression (MVR). RESULTS At recruitment, 32.2% had cirrhosis (72.9% Child Pugh class B/C), and 19.9% were treatment experienced. Of the 2,939 with data, 93.3% confirmed SVR. 137 patients received second-line therapy. Patients with cirrhosis had lower SVR rate (88.4 vs. 95.8%; p < 0.001). On MVR, failure to achieve SVR was associated with Genotype 3 (adj-OR = 0.42, 95%CI 0.29-0.61), male gender (adj-OR = 0.49, 95%CI 0.31-0.77), fair/poor adherence (adj-OR = 0.52, 95%CI 0.28-0.94), cirrhosis (adj-OR = 0.57, 95%CI 0.36-0.88), FIB-4 > 3.25 (adj-OR = 0.52, 95%CI 0.33-0.83) and MELD score ≥ 20 (adj-OR = 0.25, 95%CI 0.08-0.80). Consistent results were seen in cirrhotic sub-analysis. CONCLUSIONS Excellent SVR rates were achieved with DAAs in this real-world cohort of patients with chronic HCV infection. More advanced liver disease and clinician impression of poor adherence were associated with HCV treatment failure. Supports to improve liver fibrosis assessment skills for non-specialist DAA prescribers in the community and to optimize patient adherence are likely to enable more effective pursuit of HCV elimination in Australia.
Collapse
Affiliation(s)
- Paul J Clark
- Department of Gastroenterology, Princess Alexandra and Mater Hospitals, and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Martin Weltman
- Hepatology Services, Nepean Hospital, Penrith, NSW, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Miriam Levy
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, NSW, Australia
| | - Barbara Leggett
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, NSW, Australia
| | - Julian Rong
- Gippsland Gastroenterology, Latrobe Regional Hospital, Traralgon, VIC, 3844, Australia
| | - Peter Angus
- Department of Gastroenterology and Hepatology, Austin Hospital, Melbourne, VIC, Australia
| | - Jacob George
- Storr Liver Unit, Westmead Hospital, Westmead, NSW, Australia
| | - Steven Bollipo
- Gastroenterology Department, John Hunter Hospital, New Lambton, NSW, Australia
| | - Bruce McGarity
- Bathurst Liver Clinic Bathurst Hospital, Bathurst, NSW, Australia
| | - William Sievert
- Gastrointestinal and Liver Unit, Monash Health, Melbourne, VIC, Australia
| | - Gerry Macquillan
- Liver Transplant Unit Sir Charles Gairdner Hospital, Nedlands Perth, WA, Australia
| | - Edmund Tse
- Department of Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Amanda Wade
- Barwon Health Liver Clinic University Hospital, Geelong, VIC, Australia
| | - Geoff Chu
- Orange Liver Clinic, Orange Hospital, Orange, NSW, Australia
| | - Damian Harding
- Department of Gastroenterology & Hepatology, Lyell McEwin Hospital, Vale, SA, Australia
| | - Wendy Cheng
- Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, WA, Australia
| | - Geoff Farrell
- Gastroenterology & Hepatology Unit Canberra Hospital, Canberra, ACT, Australia
| | | |
Collapse
|
3
|
Huang N, Zhou R, Chen H, Zhang S, Li J, Wei W, Sun J, Ren S, Li B, Deng H, Yang J, Ji F, Li Z. Splenic CD4 + and CD8 + T-cells highly expressed PD-1 and Tim-3 in cirrhotic patients with HCV infection and portal hypertension. Int J Immunopathol Pharmacol 2021; 35:20587384211061051. [PMID: 34930041 PMCID: PMC8725229 DOI: 10.1177/20587384211061051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: The spleen plays an important role in regulating the immune response to infectious pathogens. T-cells dysfunction and exhaustion have been reported in patients with hepatitis B/C virus (HBV/HCV) infection, which contributes to persistent virus infection. The aims of this study were to investigate spleen-related evidence of immunosuppression and immune tolerance in HCV cirrhotic patients with portal hypertension (PH). Methods: The expression of programmed cell death 1 (PD-1), T-cell immunoglobulin domain and mucin domain-containing molecule-3 (Tim-3) and its ligand PD-L1/2, and Galectin-9 in the spleens and livers of HCV cirrhotic patients (n = 15) was analyzed using real-time PCR and immunohistochemistry. Flow cytometry was used to evaluate the expression of PD-1 and Tim-3 on splenic T-cells and the peripheral blood T-cells before and after splenectomy (n = 8). Results: Spleens from patients with PH showed significantly increased mRNA levels of PD-L2, Tim-3, Galectin-9, CD80, and CD86, and decreased levels of CD28 compared to control spleens (spleens removed due to traumatic injury) (all p < 0.05). Additionally, protein expression of inhibitory signaling molecules was significantly increased in both the spleens and livers of cirrhotic patients compared with controls (all p < 0.05). Peripheral blood and splenic CD4+ and CD8+ T-cells also expressed higher protein levels of PD-1, Tim-3, and CTLA-4 in cirrhotic patients as compared with healthy controls (all p < 0.05). The proportion of PD-1+CD4+T lymphocytes (26.2% ± 7.12% vs. 21.0% ± 9.14%, p = 0.0293) and Tim-3+CD8+ T lymphocytes (9.4% ± 3.04% vs. 6.0% ± 2.24%, p = 0.0175) in peripheral blood decreased followed splenectomy. Conclusion: The CD4+ and CD8+ T-cells in spleen and peripheral blood highly expressed PD-1 and Tim-3 in HCV-infected and cirrhotic patients with portal hypertension. Highly expressed PD-1 and Tim-3 in peripheral blood T-lymphocytes can be partly reversed following splenectomy.
Collapse
Affiliation(s)
- Na Huang
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rui Zhou
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Haiyan Chen
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shu Zhang
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jun Li
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Wei
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Oncology Surgery, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin Sun
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Song Ren
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Baohua Li
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hong Deng
- Department of Infectious Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jun Yang
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Pathology, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fanpu Ji
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Infectious Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, 117799Xi'an Jiaotong University, Ministry of Education of China, Xi'an, China
| | - Zongfang Li
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, 117799Xi'an Jiaotong University, Ministry of Education of China, Xi'an, China
| |
Collapse
|
4
|
Ji F, Li T, Nguyen MH. Improved survival and high sustained virologic response with DAA therapy in patients with HCV-related HCC: A call for expanded use. J Gastroenterol Hepatol 2021; 36:1721-1722. [PMID: 33528034 DOI: 10.1111/jgh.15420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/21/2021] [Accepted: 01/31/2021] [Indexed: 12/21/2022]
Affiliation(s)
- F Ji
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - T Li
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - M H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA.,Department of Epidemiology and Population Health, Stanford University, Palo Alto, California, USA
| |
Collapse
|