ABSTRACT
BACKGROUND: Direct-acting antivirals (DAA) are an effective treatment for hepatitis C virus infection. However, sustained virologic response (SVR) after DAA treatment does not seem to reduce the risk of hepatocellular carcinoma (HCC) development in these patients. Liver stiffness measurement (LSM) may predict the risk of developing HCC in liver cirrhosis patients. AIMS: The aim of our study was to evaluate the role of LSM variation as predictor of HCC development in patients treated with DAA. METHODS: In 139 HCV-related cirrhotic patients, LSM and laboratory tests were carried out at baseline (BL) and at the end of DAA treatment (EOT). Patients were followed for at least 6â¯months after the EOT. LSM reduction was expressed as Delta LS (∆LS). Cox regression analysis was used to identify prognostic factors for HCC development after DAA. RESULTS: Median LSM values were significantly reduced from BL to EOT (from 18.6 to 13.8â¯kPa; pâ¯<â¯0.001). The median ∆LS was -26.7% (IQR: -38.4% -13.6%). During a median follow-up of 15â¯months after DAA treatment, 20 (14.4%) patients developed HCC. Significant LSM reduction was observed both in patients who developed HCC and in those who did not, but this was significantly lower in the patients who developed HCC (-18.0% vs -28.9% pâ¯=â¯0.005). At multivariate analysis, ∆LS lower than -30%, Child-Turcotte-Pugh-B and history of HCC were independently associated with HCC development. CONCLUSION: Our results indicate that ∆LS is a useful non-invasive marker for predicting HCC development after DAA treatment.
Subject(s)
Carcinoma, Hepatocellular/diagnostic imaging , Elasticity Imaging Techniques , Hepatitis C, Chronic/drug therapy , Liver Cirrhosis/complications , Liver Neoplasms/diagnostic imaging , Aged , Antiviral Agents/therapeutic use , Carcinoma, Hepatocellular/pathology , Female , Hepacivirus/genetics , Hepatitis C, Chronic/complications , Humans , Italy , Liver Neoplasms/pathology , Male , Middle Aged , Multivariate Analysis , Proportional Hazards Models , Retrospective Studies , Risk Assessment , Sustained Virologic Response , Treatment OutcomeABSTRACT
The sequence and times of the transmission events was reported after a hospital accident by a phylodynamic reconstruction of transmission network among four subjects. The dated tree allowed to date the transmission events with good approximation, the time point and direction of each transmission, estimated on the basis of the phylogeny, and agreed with the presumptive time of infection on the basis of clinical history-taking.
