Value of non-invasive test dynamics in guiding HCC surveillance decisions after HCV cure in patients with cirrhosis

Journal of Hepatology, Год журнала: 2025, Номер unknown

Опубликована: Фев. 1, 2025

Язык: Английский

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Recompensation of decompensated cirrhosis in hepatitis C patients after SVR: Prognostic implications

Journal of Hepatology, Год журнала: 2025, Номер unknown

Опубликована: Март 1, 2025

Язык: Английский

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A Comprehensive Review of Antiviral Therapy for Hepatitis C: The Long Journey from Interferon to Pan-Genotypic Direct-Acting Antivirals (DAAs)

Viruses, Год журнала: 2025, Номер 17(2), С. 163 - 163

Опубликована: Янв. 24, 2025

The treatment landscape for hepatitis C virus (HCV) infection has transformed over the past few decades, evolving from limited efficacy of interferon (IFN) monotherapy to highly successful pan-genotypic direct-acting antivirals (DAAs) used today. Initially, alpha-interferon monotherapy, introduced in 1990s, was standard treatment, yet it provided low sustained virological response (SVR) rates and caused significant adverse effects, limiting its utility. development pegylated (peg-IFN) improved pharmacokinetic profile IFN, allowing less frequent dosing modestly rates. When combined with ribavirin, peg-IFN achieved higher SVR rates, especially non-genotype 1 HCV infections, but combination also brought additional side such as anemia depression. advent first-generation DAAs, telaprevir boceprevir, marked a milestone. Combined these protease inhibitors boosted patients genotype HCV. However, high effects drug resistance remained challenges. Second-generation like sofosbuvir ledipasvir, IFN-free regimens safety profiles efficacy. most recent advances are including glecaprevir-pibrentasvir sofosbuvir-velpatasvir, which offer across all genotypes, shorter durations, fewer effects. Current represent cornerstone therapy, providing an accessible effective solution globally.

Язык: Английский

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Response to: Unlock AI-Safe-C score's potential at all levels: Improve methods and overcome barriers

Journal of Hepatology, Год журнала: 2025, Номер unknown

Опубликована: Фев. 1, 2025

Язык: Английский

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Long‐Term Liver Morbidity and Mortality After Hepatitis C Virus Elimination by Direct‐Acting Antivirals

Journal of Gastroenterology and Hepatology, Год журнала: 2025, Номер unknown

Опубликована: Фев. 2, 2025

ABSTRACT Background and Aim More accurate stratification of patients with chronic hepatitis C after permanent virus (HCV) clearance by direct‐acting antivirals (DAAs) is important for improving long‐term surveillance treatment. The aim this study was to stratify who are at risk developing hepatocellular carcinoma (HCC) HCV cure. Methods This multicenter, retrospective cohort included 3177 consecutive adult without decompensated cirrhosis were treated all‐oral DAAs. primary endpoints cumulative de novo HCC incidence, recurrence rates, survival. Additionally, we analyzed the development cirrhosis, stratified age fibrosis status according FIB‐4 index. Results After exclusions, data from 3024 available analysis. overall median follow‐up period 6.5 years. None non‐cirrhosis/FIB‐4 < 1.45 ( n = 475) developed regardless background factors. For ≥ 3.25, older had a greater impact on incidence (log‐rank test: p 0.038). In addition, metabolic factors, including body mass index diabetes mellitus, not related incidence. commonly occurred within 5 years cure; nevertheless, cure contributed an improvement survival rates. Conclusions Age pivotal factor in predicting following moderate advanced fibrosis. Conversely, mild (FIB‐4 1.45) may be eligible discharge specialized care achieving elimination.

Язык: Английский

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The clinical challenge of managing patients after sustained virological response with direct-acting antivirals for Hepatitis C

Current Opinion in Gastroenterology, Год журнала: 2025, Номер unknown

Опубликована: Фев. 13, 2025

Purpose of review This highlights the critical considerations for monitoring patients who achieve sustained virological response (SVR) after direct-acting antiviral (DAA) therapy hepatitis C virus (HCV) infection. Despite remarkable success DAAs, challenges persist in managing long-term risks, including hepatocellular carcinoma (HCC), liver decompensation, and extrahepatic manifestations, necessitating a tailored follow-up approach. Recent findings studies emphasize that SVR does not eliminate risks complications, particularly with advanced fibrosis or cirrhosis. Advances noninvasive tools, such as transient elastography blood-based markers, have improved assessment portal hypertension function dynamics post-SVR. HCC surveillance remains high-risk groups. Additionally, improves conditions like mixed cryoglobulinemia non-Hodgkin lymphoma, though careful recurrence associated is advised. Reinfection populations underscores importance structured prevention retreatment strategies. Summary Tailored post-SVR essential. Future research should focus on refining predictive tools late complications optimizing strategies, balancing cost-effectiveness clinical outcomes.

Язык: Английский

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Surveillance in HCC: Making the Most of What We Have Today

Liver International, Год журнала: 2025, Номер 45(4)

Опубликована: Март 14, 2025

Surveillance corresponds to the systematic and repeated action of a screening test during time with goal improving survival [1]. In hepatocellular carcinoma (HCC) realm, surveillance aims reduce risk cancer-related death through detection treatment HCC at an early stage. However, recommend or not in specific population, it is crucial integrate incidence cancer together careful consideration competing risks for cost-efficacy analysis. As example, patients decompensated liver cirrhosis candidates transplantation untreatable due function comorbidities, benefit detecting vanishes since dismal non-HCC-liver-related events (overdiagnosis) [2]. While future probably leans toward personalised approaches (i.e., integration new biomarkers, more sensitive techniques such as magnetic resonance [MR]), bi-annual abdominal ultrasound (US) without alpha-fetoprotein (AFP) [3] remains cornerstone current practice. Despite strong recommendation international guidelines [4-6], underused, this may depend on both physicians lower rates primary care doctors) (low adherence) issues [7, 8]. Therefore, training doctors key objective strategies aimed enhancing adherence. A variety have been explored, education physicians, nurse-led programmes, mailed outreach strategy, EMR-led best practice alerts [9-12]. The results are heterogeneous but can achieve interesting 53% up 80%–90% these should be confirmed large-scale populations, availability expert dedicated nurses encouraged. Finally, noted that widely opinion suggests US performed by extensive expertise US. study Brahmania et al. [13] Liver International, authors retrospective aiming evaluate impact region-wide automated recall program adherence Specifically, 2013 Calgary (Canada) diagnostic-image (DI) provider created protocol-based strategy based software used breast using mammography eligible screening. healthcare (gastroenterologist, hepatologist care) was allowed enrol submitting completed one-page requisition demographic characteristics, reason screening, presence absence cirrhosis. Patients underwent biannual US, if unreachable DI team twice, two different letters from patient physician were sent. aim retention rate instead HCC-related deaths. Here, acceptable defined least one within 1 year. If frankly congratulated putting place program, definition seems suboptimal. appropriate frequency indeed proven years ago every 6 months. 3-month interval does improve > cm, annual associated comparison interval. assessing legitimacy challenging. parallel, also worth noting adherence, well methods measure it, across literature. pragmatic approach might calculate number over theoretical determined timeframe. included total 7269 between 2022, most common aetiology hepatitis B virus (51%) only 37% had fact cases indication surprising cannot explained high proportion virus. Of whole cohort, 51.8% considered retained program. This seem pooled receiving adequate 24%, lowest USA (17.8%) highest Europe (43.2%) [8]. Nonetheless, none numbers comparable non-homogeneous studies. recent Spain revealed 84% known diagnosed under [14]. sense, note positive trend concerning detected previous around 47% [15]. after median follow-up 1.89 (IQR: 1.0–4.8), per year 1.82 1.15–2.08). relativised according short study. addition, same recognise some relevant limitations, lack prospectively recorded data AFP, response therapy viral aetiology, BMI, degree portal hypertension, HCC, overall survival. realm absolutely evolving field research reasons. First, change epidemiological landscape increase C virus-cured Steatotic Disease (SLD) (with alcohol) mandates assessment groups. information needed establish programs patients. When combined revisited life expectancy (negative depending groups), death, increased outcomes patients, mandate adjusting cut-offs indications surveillance. SLD higher cardiovascular extra-hepatic cancers, could dilute risk. Second, efficacy tools has questioned terms sensitivity. well-designed randomised clinical trial reported sensitivity alone 77% [16], suggesting when properly registered, technique bad all. available underused independently definition. remarked optimisation programmes faces several interrelated challenges: sustaining established target evaluating potential expansion SLD, appropriately selecting advanced diagnostics (biomarkers MR imaging), accurately identifying high-risk individuals, delivering approaches. Balancing demands while ensuring programme sustainability complex endeavour (Figure 1). awaiting development effective adjuvant [17, 18], continues method reducing mortality populations. Personalised individual hopeful wish future. meanwhile, "Make Most What We Have Today" all and/or utmost value. note, effective, their evaluations well. They consider proper population manner. Interpretation drafting manuscript (all authors); critical revision important intellectual content authors). All approve final version manuscript. Marco Sanduzzi-Zamparelli received speaker fees Bayer AstraZeneca travel grants Bayer, BTG, Eisai, Roche; Giuseppe Cabibbo participated advisory board Ipsen, AstraZeneca, MSD, Roche, Gilead. nothing report.

Язык: Английский

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Future of Endoscopy in Surveillance of Esophageal Varices

Current Gastroenterology Reports, Год журнала: 2025, Номер 27(1)

Опубликована: Март 29, 2025

Язык: Английский

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Long-Term Hepatic and Extrahepatic Outcomes of Chronic Hepatitis C Patients After Sofosbuvir-Based Treatment (LONGHEAD Study)

Infectious Diseases and Therapy, Год журнала: 2025, Номер unknown

Опубликована: Апрель 9, 2025

Direct-acting antivirals (DAAs) are highly effective in treating hepatitis C virus (HCV) infection. The long-term hepatic and extrahepatic outcomes of DAAs chronic (CHC) patients receiving curative elusive. CHC were retrieved from two phase III sofosbuvir-based clinical trials conducted 2013-2014. Patients who achieved a sustained virological response have been followed prospectively for 5 years since 2016. A propensity score-matched interferon-based historical control with 1:3 ratio was used comparison. Quality life (QoL) measured by the SF-36, liver fibrosis electrography, fibrosis-related markers annually prospective cohort. total 160 DAA- 480 interferon-treated enrolled. Twenty-eight developed hepatocellular carcinoma (HCC) over follow-up period 4424 person-years (annual incidence: 0.6%). incidence HCC did not differ significantly between DAA cohort (P = 0.07). Cox regression analysis revealed that FIB-4 only factor independently associated development (hazard [HR]: 95% confidence interval [CI] 3.59/1.68-7.66, P 0.001). newly cardio-cerebrovascular disease 13.8 per 1000 0.9 cohort, respectively < Interferon-based had greater (HR/CI 3.39/1.28-8.96, 0.014). There substantial decrease stiffness (Ptrend 0.08) M2BPGi 0.05) significant reduction LOXL2 0.02) years. QoL observed role limitations due to physical health emotional problems, whereas other parameters maintained consistently throughout follow-up. HCV eradication improved liver- non-liver-related outcomes, constantly promoted regression, quality after cure. NCT03042520.

Язык: Английский

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Utility of tumor and non-tumor biopsies during percutaneous radiofrequency ablation for hepatocellular carcinoma

JHEP Reports, Год журнала: 2025, Номер unknown, С. 101430 - 101430

Опубликована: Апрель 1, 2025

Язык: Английский

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