Severity of white matter microstructural damage in a Brazilian relapsing-remitting multiple sclerosis cohort: A possible window to optimize treatment.

BACKGROUND: Multiple sclerosis (MS) is an important cause of acquired neurological disability in young adults, characterized by multicentric inflammation, demyelination, and axonal damage. OBJECTIVE: The objective is to investigate white matter (WM) damage progression in a Brazilian MS patient cohort, using diffusion tensor imaging (DTI) post-processed by tract-based spatial statistics (TBSS). METHODS: DTI scans were acquired from 76 MS patients and 37 sex-and-age matched controls. Patients were divided into three groups based on disease duration. DTI was performed along 30 non-collinear directions by using a 1.5T imager. For TBSS analysis, the WM skeleton was created, and a 5000 permutation-based inference with a threshold of p < .05 was used, to enable the identification of abnormalities in fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD). RESULTS: Decreased FA and increased RD, MD, and AD were seen in patients compared to controls and a decreased FA and increased MD and RD were seen, predominantly after the first 5 years of disease, when compared between groups. CONCLUSION: Progressive WM deterioration is seen over time with a more prominent pattern after 5 years of disease onset, providing evidence that the early years might be a window to optimize treatment and prevent disability.

Incidence and Risk Factors of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C Treated with Direct-Acting Antivirals.

BACKGROUND: Conflicting data regarding the incidence of hepatocellular carcinoma (HCC) after cure of HCV infection with direct-acting antivirals (DAAs) remains. We investigated the incidence and risk factors to HCC after treatment with DAAs followed up for five years. METHODS: A total of 1075 HCV patients ≥ 18 years were treated with DAAs from 2015 to 2019 and followed until 2022. Ultrasonography was performed before DAAs and each 6 months thereafter. RESULTS: Of the total, 51/1075 (4.7%) developed HCC in the median of 40 (IQR 25-58) months: 26/51 (51%) male, median age 60 (IQR 54-66) years, alpha-fetoprotein (AFP) 12.2 (IQR 6.1-18.8) ng/mL, 47/51 (92.1%) cirrhotic 78.7%, 8/51 (15.7%) without sustained virological response (SVR). Seventeen percent had non-characterized nodules before DAAs. Cumulative HCC incidence was 5.9% in 5 years. Overall incidence was 1.46/100 patient-years (PY) (95% CI = 1.09-1.91), being 2.31/100 PY (95% CI = 1.70-3.06), 0.45/100 PY (95% CI = 0.09-1.32) and 0.20/100 PY (95% CI 0.01-1.01) in METAVIR F4, F3 and F2, respectively, and the main risks to HCC were non-characterized nodule, cirrhosis, high AFP values and non-SVR. CONCLUSION: HCV cure reduced risk for HCC, but it still occurred particularly in cirrhotic patients. Some risk factors can be identified to predict early HCC diagnosis.

Outcome of liver cancer patients with SARS-CoV-2 infection: An International, Multicentre, Cohort Study.

BACKGROUND & AIMS: Information about the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with liver cancer is lacking. This study characterizes the outcomes and mortality risk in this population. METHODS: Multicentre retrospective, cross-sectional, international study of liver cancer patients with SARS-CoV-2 infection registered between February and December 2020. Clinical data at SARS-CoV-2 diagnosis and outcomes were registered. RESULTS: Two hundred fifty patients from 38 centres were included, 218 with hepatocellular carcinoma (HCC) and 32 with intrahepatic cholangiocarcinoma (iCCA). The median age was 66.5 and 64.5 years, and 84.9% and 21.9% had cirrhosis in the HCC and iCCA cohorts respectively. Patients had advanced cancer stage at SARS-CoV-2 diagnosis in 39.0% of the HCC and 71.9% of the iCCA patients. After a median follow-up of 7.20 (IQR: 1.84-11.24) months, 100 (40%) patients have died, 48% of the deaths were SARS-CoV-2-related. Forty (18.4%) HCC patients died within 30-days. The death rate increase was significantly different according to the BCLC stage (6.10% [95% CI 2.24-12.74], 11.76% [95% CI 4.73-22.30], 20.69% [95% CI 11.35-31.96] and 34.52% [95% CI 17.03-52.78] for BCLC 0/A, B, C and D, respectively; p = .0017). The hazard ratio was 1.45 (95% CI 0.49-4.31; p = .5032) in BCLC-B versus 0/A, and 3.13 (95% CI 1.29-7.62; p = .0118) in BCLC-C versus 0/A in the competing risk Cox regression model. Nineteen out of 32 iCCA (59.4%) died, and 12 deaths were related to SARS-CoV-2 infection. CONCLUSIONS: This is the largest cohort of liver cancer patients infected with SARS-CoV-2. It characterizes the 30-day mortality risk of SARS-CoV-2 infected patients with HCC during this period.

PERFIL EPIDEMIOLÓGICO DE PACIENTES COM HEPATITE C CRÔNICA TRATADOS COM ANTIVIRAIS DE AÇÃO DIRETA EM UM CENTRO DE REFERÊNCIA NO ESTADO DO RIO DE JANEIRO / EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH CHRONIC HEPATITIS C TREATED WITH DIRECT ACTION ANTIVIRALS IN A REFERENCE CENTER IN THE STATE OF RIO DE JANEIRO

Segundo o Ministério da Saúde, o número de casos notificados e confirmados de hepatite C no período entre 1999 e 2020 foi de 262.815 casos no Brasil. Em 2016, a OMS estabeleceu como objetivo global que as hepatites não fossem mais um problema de saúde pública em 2030. A partir de 2015, os agentes antivirais de ação direta (DAA) começaram a ser utilizados nessa terapêutica. O tratamento atual da hepatite C com os novos DAA revolucionou o cenário mundial com taxas de cura de até 98%. O objetivo desse artigo é apresentar e discutir o tratamento realizado com DAA em pacientes com hepatite C crônica em um centro de referência no Estado do Rio de Janeiro no período entre novembro de 2015 e julho de 2019. Trata-se de um estudo observacional, prospectivo e descritivo de pacientes com hepatite C crônica tratados com DAA no ambulatório de hepatologia de um hospital de referência. No presente estudo pode ser concluído que a maioria dos pacientes evoluiu para a cura após o tratamento. Foi possível concluir também que os esforços idealizados pela OMS para que o vírus da hepatite C seja erradicado estão ocorrendo de forma positiva e que com as novas DAAs é possível ter um número satisfatoriamente alto de RVS, evitando, assim, desfechos desfavoráveis, como por exemplo, o surgimento de carcinoma hepatocelular.

According to the Ministry of Health, the number of notified and confirmed cases of hepatitis C in the period between 1999 and 2020 was 262,815 cases in Brazil. In 2016, the WHO established as a global goal that hepatitis was no longer a public health problem in 2030. As of 2015, direct action antiviral agents (DAA) began to be used in this therapy. The current treatment of hepatitis C with the new DAA has revolutionized the world scenario with cure rates of up to 98%. The aim of this article is to present and discuss the treatment performed with DAA in patients with chronic hepatitis C in a reference center in the state of Rio de Janeiro between November 2015 and July 2019. This is an observational, prospective and descriptive study of patients with chronic hepatitis C treated with DAA in the hepatology clinic of a reference hospital. In the present study, it can be concluded that most patients evolved to cure after treatment. It was also possible to conclude that the efforts idealized by the WHO to eradicate the hepatitis C virus are occurring in a positive way and that with the new DAAs it is possible to have a satisfactorily high number of SVR, thus avoiding unfavorable outcomes, such as the appearance of hepatocellular carcinoma.

Late development of hepatocellular carcinoma after viral clearance in patients with chronic hepatitis C: A need for continual surveillance.

OBJECTIVE: Eradication of chronic hepatitis C (CHC) infection decreases the incidence of hepatocellular carcinoma (HCC), but a risk remains. We aimed to investigate HCC development-associated factors in CHC patients with sustained virological response (SVR) after antiviral therapies. METHODS: We compared CHC patients achieving SVR from 1996-2016 who did and did not develop HCC. Their median follow-up period was 8.01 years. RESULTS: Compared with 164 non-HCC SVR patients, 22 who developed HCC were older at SVR (P = 0.032), had a higher incidence of diabetes (P = 0.013) and higher pre-antiviral treatment alpha-fetoprotein (AFP) levels (P = 0.016), more had fibrosis stage 3 and cirrhosis (P = 0.0009) and hepatitis B core antibody (anti-HBc) positivity (P = 0.006). Eight and seven of 22 patients, respectively, developed HCC at 4-10 years and 10 years after SVR. The longest duration from SVR to HCC was 18.7 years. Independent factors associated with HCC development were anti-HBc positivity (hazard ratio [HR] 5.57, P = 0.012), age at SVR (HR 1.08, P = 0.014), higher pre-antiviral treatment AFP levels (HR 1.01, P = 0.01) and Hispanic ethnicity (HR 12.9, P = 0.002). HCC risk was significantly less in genotype 2 patients (HR 0.2, P = 0.02) or in those with higher pre-antiviral treatment albumin levels (HR 0.33, P = 0.04). CONCLUSIONS: The risk for HCC exists in a subset of CHC patients after SVR and may occur up to 18 years after viral clearance. Indefinite HCC surveillance is necessary in SVR patients with other risk factors.