ABSTRACT
Objective: The development of hepatocellular carcinoma (HCC) is not uncommon in patients who achieve eradication of the hepatitis C virus through direct-acting antiviral (DAA) treatment. The aim of this study was to identify the patients at high risk for novel HCC development after a sustained virologic response (SVR) by DAA treatment.Patients and Methods: A total of 518 patients with no history of HCC treatment and who achieved SVR by DAA treatment were evaluated retrospectively. The correlations between HCC development and the patients’ characteristics were evaluated. For patients who underwent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) or dynamic contrast-enhanced computed tomography, the relationship between the imaging findings and subsequent HCC development was also assessed.Results: HCC developed newly in 22 patients, and the 1-year and 3-year cumulative HCC rates were 2.0% and 8.5%, respectively. In multivariate analysis, a FIB-4 index >4.0 and a post-treatment α-fetoprotein >4.0 ng/ml were significant risk factors for HCC. In 26 of 118 patients who underwent an MRI before DAA treatment, a non-hypervascular hypo-intense nodule was seen in the hepatobiliary phase, and in 6 of 182 patients who underwent a CT, a non-hypervascular hypo-enhanced nodule was seen in the delayed phase. The sensitivity and specificity of the MRI-positive findings for the subsequent development of HCC were 0.92 and 0.87, respectively, and those of the CT were 0.40 and 0.99, respectively. In multivariate analysis of patients who underwent an MRI, a non-hypervascular hypo-intense nodule was the only factor that was significantly related to HCC development (HR 32.4, p = 0.001).Conclusion: Gd-EOB-DTPA-enhanced MRI was found to be reliable for risk evaluation of subsequent HCC development in patients after SVR by DAA treatment. Patients with a non-hypervascular hypo-intense nodule need more careful observation for incident HCC.
ABSTRACT
Background: Interleukin-10 (IL-10) and IL–12B single nucleotide polymorphisms (SNPs) are confirmed to influence the natural history of hepatitis C virus (HCV) infection, and the response to treatment. This work aimed at evaluating the impact of SNPs in IL-10 gene at positions _1082, _819, and_592 and IL-12B gene on the response to the standard of care (SOC) treatment in Egyptian patients with chronic HCV. Methods: Eighty seven patients with chronic HCV treated by SOC therapy and 20 healthy controls were tested for SNPs in IL-10 at _1082 G/A, _819 C/T and_592 C/A and in IL- 12B (30-UTR 1188-A/C) by polymerase chain reaction (PCR). Patients were divided according to their virologic response into 2 groups; group Ι=patients who achieved sustained virologic response (SVR) and group Π = non responder (NR) patients. Results: SNPs of IL-10 at _1082 G/A and_819 C/T showed that; GA and TT genotypes were significantly related to SVR (P=0.001 and 0.007 respectively). IL-12 genepolymorphisms showed that; CC genotype was significantly related to SVR group (P=0.01) while AA genotype was significantly related to NR (P=0.01). Conclusions: Studying SNPs of IL-10_1082 G/A, IL-10_819 C/T and IL-12B (30-UTR 1188-C/A) proved GA, TT and CC genotypes, respectively, to be good predictors for SVR. Conversely, SNPs of IL-12 C/A proved AA genotype to be good predictor for NR.