A Corma-Gómez, A. et al. HIV infection is associated with lower risk of hepatocellular carcinoma after sustained virological response to direct-acting antivirals in hepatitis C infected-patients with advanced fibrosis. Clin Infect Dis 2020, published August 7^th, ciaa1111, https://doi.org/10.1093/cid/ciaa1111

Most HIV/HCV co-infected persons in the U.S. have been treated with direct acting antiviral agents (DAAs) and achieved a sustained virologic response (SVR) following completion of therapy. There is little data however regarding the risk of hepatic complications, including hepatocellular carcinoma (HCC) after HCV cure. This multisite cohort study from Spain included HCV-monoinfected and HIV/HCV-coinfected patients. Inclusion criteria were: 1) SVR after 12 weeks with DAA-based combination; 2) Pre-treatment liver stiffness (LS) by elastography of ≥9.5 kPa; 3) LS measurement done at the SVR time-point. The primary endpoint was the de novo occurrence of HCC. The secondary endpoint was development of liver decompensation other than HCC. There were 1035 HCV-infected patients in the cohort, 667 (64%) were coinfected with HIV. After a median follow-up of 43 months, 11 (3.0%) of the HCV-monoinfected and 8 (1.2%) of the coinfected individuals developed HCC. In the multivariable analysis, HIV co-infection was associated with a lower adjusted risk of developing HCC. Predictors of HCC included age, HCV genotype 3, MELD score at SVR>10 and LS value at time of SVR. Approximately 3% of patients in both groups experienced hepatic decompensation.

The findings of this study are rather surprising and the inverse of what was seen in the pre-DAA era. Moreover, the HIV/HCV coinfected patients in this study actually had more advanced liver disease at baseline. The authors cite several possible reasons for their findings including a possible protective role of ART and that the monoinfected patients may have had a longer time of exposure to HCV. In addition, concomitant causes of liver diseases, such as alcoholic or non-alcoholic fatty liver disease were not analyzed in this study. Regardless, these data provide some reassurance for HIV/HCV patients who have attained an SVR after treatment with DAAs.

The author has no conflicts of interest to disclose.