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Risk of hepatocellular carcinoma recurrence after the use of direct-acting antivirals in the treatment of hepatitis C: a systematic review and metanalysis
Hepatitis C is associated with the development of hepatocellular carcinoma. The therapeutic regimen based on interferon has been replaced by direct-acting antivirals to treat HCV infection. However, recent studies have shown an unexpected increase in hepatocellular carcinoma recurrence in patients treated with this new regimen of antivirals.
To assess the risk of hepatocelullar carcinoma recurrence after using direct-acting antivirals in patients with HCV infection
A survey was carried out in the PUBMED, MEDLINE, and LILACS databases according to the descriptors DeCS / MeSH ((hepatocellular carcinoma) AND recurrence) AND direct-acting antiviral. The review followed the PRISMA protocol and is registered on the PROSPERO platform. The statistical analysis of the data was performed using the RStudio software.
7 articles were selected resulting in 847 patients. Among those treated with direct-acting antivirals, the recurrence rate varied between 11.1% to 42.1% and, in the control group, it occurred in 5% to 65.6% of the patients. The relative risk (RR) of recurrence of hepatocellular carcinoma in the group of patients who received direct-acting antivirals was less than the risk evidenced in the control group (RR 0.71 95% CI [0.55; 0.93] I² = 38%, p = 0.14). The time until the diagnosis of recurrence averaged 9.35 months in the group exposed to therapy and 13.42 months in the control group.
It is suggested that therapy with direct-acting antivirals does not increase the risk of recurrence of hepatocellular carcinoma compared to control groups. In patients who developed recurrence, it occurred more frequently within the first year after the introduction of the therapy.
Hepatocellular carcinoma; Recurrence; Antiviral Agents
Fígado / Pâncreas / Vias Biliares
AMANDA DA SILVA ANJOS, JEFFERSON WRUBLACK CUBA, EDIMAR LEANDRO TODERKE, FILIPE VIEIRA KWIATKOWSKI