背景:丙型肝炎病毒(HCV)感染影响全球5000万人,每年约有242,000人死亡,主要是由于肝硬化和肝细胞癌(HCC)等并发症。肝硬化引起的门脉高压(PH)会导致严重后果,包括食管静脉曲张(EV)。本研究旨在评估有和没有EV的患者的直接作用抗病毒(DAA)治疗的有效性和安全性。
方法:本回顾性分析涉及2015年7月1日至2022年12月31日在波兰22个肝病中心连续接受DAA治疗的HCV感染成人。肝硬化患者根据胃镜诊断的EV的存在进行分类。通过持续病毒学应答(SVR)来衡量治疗效果,治疗后12周监测安全性结果。
结果:将3393例HCV感染肝硬化患者的人群分为(A,n=976)和无(B,n=2417)EV。A组显示合并症和合并用药的患病率明显更高。基因型(GT)1b感染在两组中占主导地位,GT3感染在EV组中更为常见。A组表现出更严重的肝脏疾病,更高的失代偿率,HCC,和HBV共感染。B组SVR明显高于B组(91.5%vs.96.3%,p<0.0001)。男性,GT3,电动汽车存在,Child-PughB级被确定为独立的负SVR预测因子。A组的安全性较差,不良事件发生率和死亡率明显较高。
结论:DAA治疗对肝硬化患者非常有效且耐受性良好,但EV的存在预示着较差的病毒学反应。
BACKGROUND: Hepatitis C virus (HCV) infection affects 50 million people worldwide with around 242,000 deaths annually, mainly due to complications such as cirrhosis and hepatocellular carcinoma (HCC). Portal hypertension (PH) caused by cirrhosis leads to severe consequences, including esophageal varices (EV). This study aimed to evaluate the effectiveness and safety of direct-acting antiviral (DAA) treatment in patients with and without EV.
METHODS: This retrospective analysis involved consecutive HCV-infected adults undergoing DAA therapy at 22 Polish hepatology centers from July 1, 2015, to December 31, 2022. Patients with cirrhosis were categorized based on the presence of EV diagnosed by gastroscopy. Treatment effectiveness was measured by sustained virologic response (SVR), with safety outcomes monitored for 12 weeks post-treatment.
RESULTS: A population of 3393 HCV-infected patients with cirrhosis was divided into groups with (A, n = 976) and without (B, n = 2417) EV. Group A showed a significantly higher prevalence of comorbidities and concomitant medications. Genotype (GT)1b infections predominated in both groups, and GT3 infections were more common in the EV group. Group A exhibited more severe liver disease, and higher rates of decompensation, HCC, and HBV co-infection. SVR was significantly higher in group B (91.5% vs. 96.3%, p < 0.0001). Male gender, GT3, EV presence, and Child-Pugh grade B were identified as independent negative SVR predictors. Group A had a worse safety profile, with notably higher adverse event incidence and mortality.
CONCLUSIONS: DAA therapies are highly effective and well tolerated in patients with cirrhosis, but EV presence predicts poorer virologic responses.