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A Single Center Study of the Treatment Outcome of HCV and the Long-term Prognosis in Patients with HIV/HCV-Coinfection
1)Department of infectious disease, National Hospital Organization Fukuyama Medical Center, 2)Division of Blood Transfusion, Hiroshima University Hospital, 3)Division of AIDS Care Unit, Hiroshima University Hospital, 4)Division of Laboratory Medicine, Chuden Hospital
Seiji SAITO1)2)3), Naoya YAMASAKI2)3), Teruhisa FUJII2)3) & Noboru TAKATA4)
(Received January 23, 2017)
(Accepted June 22, 2017)
Key words: HIV, HCV, coinfection, interferon, hemophilia

Background: Liver fibrosis progresses earlier and the prevalence of hepato cellular carcinoma (HCC) is higher in HIV/HCV-coinfected patients compared with HCV-monoinfected patients. More careful observation is necessary for patients with advanced liver fibrosis and elderly patients after achieving a sustained virologic response (SVR) with interferon (IFN)-based therapy owing to the high prevalence of HCC. Though an increase of fatalities becomes the problem in HIV/HCV-coinfected patients, mostly through hemophilia, transmitted from non-heated plasma-derived products more than 30 years ago, there are few reports which have investigated the long-term prognosis in Japan.

Materials and Methods: The subjects were 15 HIV/HCV-coinfected patients (5%) among 313 HIV infected patients at Hiroshima University Hospital from April 2005 to October 2016, and we collected data retrospectively from the clinical records regarding the treatment history and outcome of HCV and the long-term prognosis.

Results: From 12 patients among the subjects who were treated with IFN-based regimen, 10 patients (83%) had achieved an SVR. The median age was 50 years and the median observation period was 118 months in 7 patients out of 10 (long-term observation group) who were observed for more than 24 months, and there has been no case of recurrence case in this group. From 4 patients among 5 with a detectable HCV viral load (the detectable viral load group) including 2 previously untreated patients who were treated with Direct Acting Antivirals (DAAs), 3 patients achieved a viral response. One patient developed HCC in both the long-term observation group and detectable viral load group. Both of them were HCV genotype 3a, and had a risk factor for HCC such as diabetes mellitus and drinking alcohol. The results of the liver biopsies were A3, F4 grade (new Inuyama classification) at the point of the operation for HCC.

Conclusions: The treatment outcome for HIV/HCV-coinfected patients was mostly good in our hospital. However, there were cases of onset of HCC in HIV/HCV-coinfected patients similar to that seen in HCV-monoinfected patients regardless of achieving SVR with IFN-based therapy. Clinicians should perform a screening examination for HCC more carefully in patients with advanced liver fibrosis and risk factors for HCC development.

[ Kansenshogaku Zasshi 91: 924-929, 2017 ]

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