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      Increased recurrence rates of hepatocellular carcinoma after DAA therapy in a hepatitis C-infected Egyptian cohort: A comparative analysis

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          Abstract

          In Egypt, hepatocellular carcinoma (HCC) is the most common form of cancer and direct-acting antivirals (DAA) are administered on a large scale to patients with chronic HCV infection to reduce the risk. In this unique setting, we aimed to determine the association of DAA exposure with early-phase HCC recurrence in patients with a history of HCV-related liver cancer. This was a prospective cohort study of an HCV-infected population from one Egyptian specialized HCC management centre starting from the time of successful HCC intervention. The incidence rates of HCC recurrence between DAA-exposed and nonexposed patients were compared, starting from date of HCC complete radiological response and censoring after 2 years. DAA exposure was treated as time varying. Two Poisson regressions models were used to control for potential differences in the exposed and nonexposed group; multivariable adjustment and balancing using inverse probability of treatment weighting (IPTW). We included 116 patients: 53 treated with DAAs and 63 not treated with DAAs. There was 37.7% and 25.4% recurrence in each group after a median of 16.0 and 23.0 months of follow-up, respectively. Poisson regression using IPTW demonstrated an association between DAAs and HCC recurrence with an incidence rate ratio of 3.83 (95% CI: 2.02-7.25), which was similar in the multivariable-adjusted model and various sensitivity analyses. These results add important evidence towards the possible role of DAAs in HCC recurrence and stress the need for further mechanistic studies and clinical trials to accurately confirm this role and to identify patient characteristics that may be associated with this event.

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          Author and article information

          Journal
          Journal of Viral Hepatitis
          J Viral Hepat
          Wiley
          13520504
          June 2018
          June 2018
          January 24 2018
          : 25
          : 6
          : 623-630
          Affiliations
          [1 ]Endemic Medicine Department; Faculty of Medicine; Helwan University; Cairo Egypt
          [2 ]Emerging Disease Epidemiology Unit; Institut Pasteur; Paris France
          [3 ]Tropical Medicine Department; Faculty of Medicine; Ain Shams University; Cairo Egypt
          [4 ]Laboratoire MESuRS (EA 4628); Conservatoire National Des Arts et Métiers; Paris France
          [5 ]Unité PACRI; Institut Pasteur, Conservatoire National des Arts et Métiers; Paris France
          [6 ]New Cairo Viral Hepatitis Treatment Unit; Cairo Egypt
          [7 ]National Hepatology and Tropical Medicine Research Institute; Cairo Egypt
          [8 ]Medical Surgical Nursing Department; Faculty of Nursing; Cairo University; Cairo Egypt
          [9 ]Endemic Medicine and Hepato-Gastroenterology Department; Faculty of Medicine; Cairo University; Cairo Egypt
          Article
          10.1111/jvh.12854
          29274197
          529a2ebe-a7c2-4551-a9a4-58ffcb933447
          © 2018

          http://doi.wiley.com/10.1002/tdm_license_1.1

          http://onlinelibrary.wiley.com/termsAndConditions#vor

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