Is There a Risk of Extrahepatic Cancer After DAA Treatment in HIV/HCV Co-Infected Patients: Presented at ECCMID

By Shazia Qureshi

AMSTERDAM, the Netherlands -- April 18, 2019 -- A small retrospective study reported here at the 29th European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) shows a possibly elevated rate of extrahepatic cancers in patients co-infected with HIV and hepatitis C virus (HCV) who underwent treatment with direct-acting antivirals (DAAs) for their HCV.

David Zucman, MD, Hôpital Foch, Suresnes, France, and colleagues retrospectively evaluated patient data from their hospital and found that 93 patients with HIV and HCV co-infection had been successfully treated for HCV from 2000 until 2017.

Around 53 of the patients were treated with DAAs once they became common, around 2014. Prior to that, an HCV cure had been accomplished with interferon-based therapies in 40 patients.

Looking at cancer incidence among both groups until 2018, the researchers calculated that the incidence rate of extrahepatic cancers was 48.5 (95% confidence interval [CI], 15.0-82.1) per 1,000 person-years among the DAA group, compared with 2.4 (95% CI, 0-7.2) per 1,000 person-years in the interferon group. This difference was found to be significant between the 2 groups in Kaplan-Meier analysis (log-rank test, P = .001).

Among the patients who had received DAAs, 8 patients developed extrahepatic cancers after a median of 20 months (range, 1-48) and 3 of them died due to the cancer. Among the interferon-treated group, only 1 patient developed an extrahepatic cancer 7 years after treatment, but it was not fatal.

When the researchers looked at other potential factors that might have differed between patients with and without extrahepatic cancers, they found that the CD4 T-cell nadir count was significant. Patients who developed extrahepatic cancers had a median CD4 nadir of 70 cells/mm3 compared with a median of 209.5 cells/mm3 among those who had not developed extrahepatic cancers (P = .003).

“The occurrence of such extrahepatic cancers could be mediated by an immune mechanism induced by HCV clearance,” the authors suggested.

However, since it was a small study in 1 hospital, the authors also said that larger cohorts need to be evaluated.

[Presentation title: Is There a Risk of Extrahepatic Cancer After Direct-Acting Antiviral Treatment in HIV/HCV Co-Infected Patients? Abstract P0706]

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