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Open Access 01-11-2019 | Hepatitis B | Guidelines

APASL HCV guidelines of virus-eradicated patients by DAA on how to monitor HCC occurrence and HBV reactivation

Authors: Tatsuo Kanda, George K. K. Lau, Lai Wei, Mitsuhiko Moriyama, Ming-Lung Yu, Wang-Long Chuang, Alaaeldin Ibrahim, Cosmas Rinaldi Adithya Lesmana, Jose Sollano, Manoj Kumar, Ankur Jindal, Barjesh Chander Sharma, Saeed S. Hamid, A. Kadir Dokmeci, Mamun-Al-Mahtab, Geoffrey W. McCaughan, Jafri Wasim, Darrell H. G. Crawford, Jia-Horng Kao, Yoshihiko Ooka, Osamu Yokosuka, Shiv Kumar Sarin, Masao Omata

Published in: Hepatology International | Issue 6/2019

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.

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Title: APASL HCV guidelines of virus-eradicated patients by DAA on how to monitor HCC occurrence and HBV reactivation
Authors: Tatsuo Kanda
George K. K. Lau
Lai Wei
Mitsuhiko Moriyama
Ming-Lung Yu
Wang-Long Chuang
Alaaeldin Ibrahim
Cosmas Rinaldi Adithya Lesmana
Jose Sollano
Manoj Kumar
Ankur Jindal
Barjesh Chander Sharma
Saeed S. Hamid
A. Kadir Dokmeci
Mamun-Al-Mahtab
Geoffrey W. McCaughan
Jafri Wasim
Darrell H. G. Crawford
Jia-Horng Kao
Yoshihiko Ooka
Osamu Yokosuka
Shiv Kumar Sarin
Masao Omata
Publication date: 01-11-2019
Publisher: Springer India
Keywords: Hepatitis B
Entecavir
Hepatocellular Carcinoma
Hepatitis C
Hepatocellular Carcinoma
Published in: Hepatology International / Issue 6/2019
Print ISSN: 1936-0533
Electronic ISSN: 1936-0541
DOI: https://doi.org/10.1007/s12072-019-09988-7

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Other articles of this Issue 6/2019

Sarcopenia and fatty liver disease

Complications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia–Pacific region

Cellular and functional loss of liver endothelial cells correlates with poor hepatocyte regeneration in acute-on-chronic liver failure

Preoperative transcatheter arterial chemoembolization for surgical resection of huge hepatocellular carcinoma (≥ 10 cm): a multicenter propensity matching analysis