Nicolás Merchante

Hospital Universitario de Valme

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Juan A. Pineda

Hospital Universitario de Valme

Juan Macı́as

Hospital Universitario de Valme

Antonio Rivero

Hospital Universitario Nuestra Señora de Candelaria

António Rivero‐Juarez

Instituto Maimónides de Investigación Biomédica de Córdoba

Francisco Téllez

Hospital Universitario Puerto Real

Dolores Merino

Hospital Juan Ramón Jiménez

Luís Miguel Real

Hospital Universitario de Valme

Karin Neukam

Hospital Universitario Virgen del Rocío

Ignacio de los Santos

Universidade Estadual de Campinas (UNICAMP)

Esperanza Merino

Hospital General Universitario de Alicante Doctor Balmis

Cooperative Institutions

Instituto de Salud Carlos III

426

Centro de Investigación Biomédica en Red

312

Hospital Universitario La Paz

294

Universidad Autónoma de Madrid

185

Evidence (Italy)

169

Instituto de Biomedicina de Sevilla

164

Universidad de Sevilla

158

Hospital Universitario Ramón y Cajal

137

Hospital Universitario Virgen Macarena

125

Universitat de Barcelona

123

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Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis

Gut (2021)

Víctor Sapena Marco Enea Ferrán Torres Ciro Celsa José Ríos

Objective The benefit of direct-acting antivirals (DAAs) against HCV following successful treatment of hepatocellular carcinoma (HCC) remains controversial. This meta-analysis of individual patient data assessed HCC recurrence risk following DAA administration. Design We pooled the data of 977 consecutive patients from 21 studies of HCV-related cirrhosis and HCC, who achieved complete radiological response after surgical/locoregional treatments and received DAAs (DAA group). Recurrence or death risk was expressed as HCC recurrence or death per 100 person-years (100PY). Propensity score-matched patients from the ITA.LI.CA. cohort (n=328) served as DAA-unexposed controls (no-DAA group). Risk factors for HCC recurrence were identified using random-effects Poisson. Results Recurrence rate and death risk per 100PY in DAA-treated patients were 20 (95% CI 13.9 to 29.8, I 2 =74.6%) and 5.7 (2.5 to 15.3, I 2 =54.3), respectively. Predictive factors for recurrence were alpha-fetoprotein logarithm (relative risk (RR)=1.11, 95% CI 1.03 to 1.19; p=0.01, per 1 log of ng/mL), HCC recurrence history pre-DAA initiation (RR=1.11, 95% CI 1.07 to 1.16; p<0.001), performance status (2 vs 0, RR=4.35, 95% CI 1.54 to 11.11; 2 vs 1, RR=3.7, 95% CI 1.3 to 11.11; p=0.01) and tumour burden pre-HCC treatment (multifocal vs solitary nodule, RR=1.75, 95% CI 1.25 to 2.43; p<0.001). No significant difference was observed in RR between the DAA-exposed and DAA-unexposed groups in propensity score-matched patients (RR=0.64, 95% CI 0.37 to 1.1; p=0.1). Conclusion Effects of DAA exposure on HCC recurrence risk remain inconclusive. Active clinical and radiological follow-up of patients with HCC after HCV eradication with DAA is justified.

Antiviral Therapy

10.1136/gutjnl-2020-323663

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Citations (85)

Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis

Hepatology (2012)

Nicolás Merchante António Rivero‐Juarez Francisco Téllez Dolores Merino Maria José Ríos-Villegas

Our aim was to assess the predictive value of liver stiffness (LS), measured by transient elastography (TE), for clinical outcome in human immunodeficiency virus / hepatitis C virus (HIV/HCV)-coinfected patients with compensated liver cirrhosis. This was a prospective cohort study of 239 consecutive HIV/HCV-coinfected patients with a new diagnosis of cirrhosis, done by TE, and no previous decompensation of liver disease. The time from diagnosis to the first liver decompensation and death from liver disease, as well as the predictors of these outcomes, were evaluated. After a median (Q1-Q3) follow-up of 20 (9-34) months, 31 (13%, 95% confidence interval [CI]: 9%-17%) patients developed a decompensation. The incidence of decompensation was 6.7 cases per 100 person-years (95% CI, 4.7-9-6). Fourteen (8%) out of 181 patients with a baseline LS < 40 kPa developed a decompensation versus 17 (29%) out of 58 with LS ≥ 40 kPa ( P = 0.001). Factors independently associated with decompensation were Child-Turcotte-Pugh (CTP) class B versus A (hazard ratio [HR] 7.7; 95% CI 3.3-18.5; P < 0.0001), log-plasma HCV RNA load (HR 2.1; 95% CI 1.2-3.6; P = 0.01), hepatitis B virus coinfection (HR, 10.3; 95% CI, 2.1-50.4; P = 0.004) and baseline LS (HR 1.03; 95% CI 1.01-1.05; P = 0.02). Fifteen (6%, 95% CI: 3.5%-9.9%) patients died, 10 of them due to liver disease, and one underwent liver transplantation. CTP class B (HR 16.5; 95% CI 3.4-68.2; P < 0.0001) and previous exposure to HCV therapy (HR 7.4; 95% CI 1.7-32.4, P = 0.007) were independently associated with liver-related death; baseline LS (HR 1.03; 95% CI 0.98-1.07; P = 0.08) was of borderline significance. Conclusion: LS predicts the development of hepatic decompensations and liver-related mortality in HIV/HCV-coinfection with compensated cirrhosis and provides additional prognostic information to that provided by the CTP score. (HEPATOLOGY 2012;56:228–238)

Hepatitis C

Hepatitis virus

10.1002/hep.25616

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Citations (83)

Intoxicación digitálica secundaria a una alteración del metabolismo intestinal de la digoxina en una paciente tratada con claritromicina

Medicina Clínica (2004)

Salvador Vergara-López José Ángel García-García Nicolás Merchante José Antonio López Mira

10.1016/s0025-7753(04)74629-1

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Citations (1)

660 HIV/HCV-COINFECTED PATIENTS WHO ACHIEVED SVR ARE STILL AT RISK OF DEVELOPING HEPATOCELLULAR CARCINOMA

Journal of Hepatology (2013)

Nicolás Merchante E Merino C. Tural António Rivero‐Juarez Francisco Jover

10.1016/s0168-8278(13)60662-5

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Management of HCV-related end-stage liver disease in HIV-coinfected patients.

PubMed (2007)

Nicolás Merchante Manuel Jiménez‐Sáenz Juan A. Pineda

End-stage liver disease due to hepatitis C virus has become a major challenge in the management of HIV/HCV-coinfected patients. The diagnosis and management of cirrhosis and its complications in the scenario of HIV/HCV-coinfection are reviewed. Noninvasive approaches to the diagnosis of cirrhosis, such as biomarkers or transient hepatic elastography, may be considered. The clinical profile of cirrhosis decompensation in the coinfected population is different from that found in HCV-monoinfected individuals. Ascites and hepatic encephalopathy are much more frequent, whereas hepatocellular carcinoma is still uncommon, when simultaneous hepatitis B virus infection is absent. The newest and more conflicting topics on the management of these complications are also discussed. Liver transplantation seems to be a proper option of treatment in HIV/HCV-coinfected patients and should be considered early in their management, since mortality after the first hepatic decompensation is high.

Decompensation

Transient elastography

Hepatic Encephalopathy

Liver disease

Hepatitis C

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Citations (21)

642 BARCELONA-CLINIC-LIVER-CANCER (BCLC) STAGING AND ACTUAL THERAPY RECEIVED IN HIV-INFECTED PATIENTS WITH HEPATOCELLULAR CARCINOMA (HCC), COMPARING DIAGNOSIS PRE-2006 AND 2006 AND LATER

Journal of Hepatology (2011)

Nicolás Merchante Luciana Kikuchi Kate Marks Antonio Rivero Erica E. Palys

Liver Cancer

10.1016/s0168-8278(11)60644-2

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Citations (1)

Transient Budd-Chiari Syndrome due to Iatrogenic Subcapsular Fluid Accumulation Following Thoracocentesis

The American Journal of Gastroenterology (2004)

Manuel Romero‐Gómez Marta Ramirez-Martin-dei Campo Nicolás Merchante Jorge Escalada-Berta

Transient Budd-Chiari Syndrome due to Iatrogenic Subcapsular Fluid Accumulation Following Thoracocentesis

Budd–Chiari syndrome

Transient (computer programming)

10.1111/j.1572-0241.2004.40695_5.x

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Prediction of liver stiffness by serum indexes in HCV-infected patients with or without HIV coinfection

Medicine (2021)

Nicolás Merchante Álvaro Mena Juan-Manuel Pascasio Andrés Marco Manuel Rodríguez

Identification of advanced fibrosis/cirrhosis in hepatitis C virus (HCV)-infected patients should be a mainstay before starting treatment; however, the limited access of many centres to transient elastography (TE) is often a barrier for early assessments. We aimed to investigate the diagnostic accuracy of serum indexes for predicting liver stiffness.Retrospective analysis of HCV patients (with or without HIV coinfection) routinely assessed in 7 centres in Spain. The diagnostic accuracy of aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 (FIB-4), and their combinations was evaluated using a recent TE examination as a reference test (liver stiffness ≥ 9.5 kPa and ≥12.5 kPa for advanced fibrosis and cirrhosis, respectively). In addition to area under the receiving operating characteristic curves, sensitivity, specificity, and negative predictive value (NPV) and positive predictive value were estimated.The analysis included 1391 patients: 346 (25%) HIV-positive, 732 (53%) people who inject drugs, and 178 (13%) incarcerated. Advanced fibrosis and cirrhosis were found in 557 (40%) and 351 (25%) patients, respectively. APRI < 0.5 (n = 595; 43%) had an NPV of 95% for excluding cirrhosis. Combined FIB-4 < 1.45 with APRI < 0.5 (n = 467; 34%) had an NPV of 87% for excluding advanced fibrosis. Combined APRI > 2 and FIB-4 > 3.25 (n = 134; 10%) had a positive predictive value of 89% for advanced fibrosis. Globally, this approach would avoid the need for TE in 53% of patients. HIV coinfection did not influence diagnostic accuracy.Inexpensive and simple serum indexes confidently allowed identifying the absence of cirrhosis and the presence of advanced fibrosis in 53% of a heterogeneous series of real-world HCV patients with or without HIV infection.

10.1097/md.0000000000027838

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Citations (2)

Efficacy of chronic hepatitis C therapy with pegylated interferon and ribavirin in patients on methadone maintenance treatment

European Journal of Clinical Microbiology & Infectious Diseases (2011)

Karin Neukam J. A. Mira Isabel Gilabert Evangelina Claro María J. Vázquez

Pegylated interferon

Hepatitis C

Methadone maintenance

10.1007/s10096-011-1433-5

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Citations (6)

Early Use of Sarilumab in Patients Hospitalized with COVID-19 Pneumonia and Features of Systemic Inflammation: the SARICOR Randomized Clinical Trial

Antimicrobial Agents and Chemotherapy (2021)

Nicolás Merchante Sheila Cárcel José C. Garrido-Gracia Marta Trigo-Rodríguez María Ángeles Esteban Moreno

The objective of this study was to investigate the efficacy and safety of early treatment with sarilumab, added to standard of care (SOC), in hospitalized adults with COVID-19. Methods included phase II, open-label, randomized, controlled clinical trial of hospitalized patients with COVID-19 pneumonia and interleukin (IL)-6 levels ≥ 40 pg/mL and/or d-dimer > 1,500 ng/mL.

2019-20 coronavirus outbreak

10.1128/aac.02107-21

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Citations (25)