Outcomes assessment of hepatitis C virus-positive psoriatic patients treated using pegylated interferon in combination with ribavirin compared to new Direct-Acting Antiviral agents
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摘要
AIM To evaluate the outcomes in biological treatment and quality of life of psoriatic patients with chronic hepatitis C(CHC) treated with new Direct-Acting Antiviral agents(DAAs) compared to pegylated interferon-2α plus ribavirin(P/R) therapy.METHODS This is a retrospective study involving psoriatic patients in biological therapy who underwent anti-hepatitis C virus(HCV) treatment at the Department of Dermatology Galeazzi Orthopaedic Institute Milan, Italy from January 2010 to November 2017. The patients were divided into two groups: patients that underwent therapy with DAAs and patients that underwent HCV treatment with P/R. Patients were assessed by a dermatologist for psoriasis symptoms, collecting Psoriasis Area Severity Index(PASI) scores and the Dermatology Quality of Life Index(DLQI). PASI and DLQI scores were evaluated 24 wk after the end of HCV treatment and were assumed as an outcome of the progression of psoriasis. Switching to a different b DMARD was considered as an inadequate response to biological therapy. The dropout of HCV therapy and sustained virological response(SVR) were considered as outcomes of HCV therapy.RESULTS Fifty-nine psoriatic patients in biological therapy underwent antiviral therapy for CHC. Of this, 27 patients were treated with DAAs and 32 with P/R. After 24 wk post treatment, the DLQI and the PASI scores were significantly lower(P < 0.001 and P < 0.005, respectively) in the DAAs group compared with P/R group. None of the patients in the DAAs group(0/27) compared to 8 patients of the P/R group(8/32) needed a shift in biological treatment.CONCLUSION DAAs seem to be more effective and safe than P/R in HCV-positive psoriatic patients on biological treatment. Fewer dermatological adverse events may be due to interferon-free therapy.
AIM To evaluate the outcomes in biological treatment and quality of life of psoriatic patients with chronic hepatitis C(CHC) treated with new Direct-Acting Antiviral agents(DAAs) compared to pegylated interferon-2α plus ribavirin(P/R) therapy.METHODS This is a retrospective study involving psoriatic patients in biological therapy who underwent anti-hepatitis C virus(HCV) treatment at the Department of Dermatology Galeazzi Orthopaedic Institute Milan, Italy from January 2010 to November 2017. The patients were divided into two groups: patients that underwent therapy with DAAs and patients that underwent HCV treatment with P/R. Patients were assessed by a dermatologist for psoriasis symptoms, collecting Psoriasis Area Severity Index(PASI) scores and the Dermatology Quality of Life Index(DLQI). PASI and DLQI scores were evaluated 24 wk after the end of HCV treatment and were assumed as an outcome of the progression of psoriasis. Switching to a different b DMARD was considered as an inadequate response to biological therapy. The dropout of HCV therapy and sustained virological response(SVR) were considered as outcomes of HCV therapy.RESULTS Fifty-nine psoriatic patients in biological therapy underwent antiviral therapy for CHC. Of this, 27 patients were treated with DAAs and 32 with P/R. After 24 wk post treatment, the DLQI and the PASI scores were significantly lower(P < 0.001 and P < 0.005, respectively) in the DAAs group compared with P/R group. None of the patients in the DAAs group(0/27) compared to 8 patients of the P/R group(8/32) needed a shift in biological treatment.CONCLUSION DAAs seem to be more effective and safe than P/R in HCV-positive psoriatic patients on biological treatment. Fewer dermatological adverse events may be due to interferon-free therapy.
AIM To evaluate the outcomes in biological treatment and quality of life of psoriatic patients with chronic hepatitis C(CHC) treated with new Direct-Acting Antiviral agents(DAAs) compared to pegylated interferon-2α plus ribavirin(P/R) therapy.METHODS This is a retrospective study involving psoriatic patients in biological therapy who underwent anti-hepatitis C virus(HCV) treatment at the Department of Dermatology Galeazzi Orthopaedic Institute Milan, Italy from January 2010 to November 2017. The patients were divided into two groups: patients that underwent therapy with DAAs and patients that underwent HCV treatment with P/R. Patients were assessed by a dermatologist for psoriasis symptoms, collecting Psoriasis Area Severity Index(PASI) scores and the Dermatology Quality of Life Index(DLQI). PASI and DLQI scores were evaluated 24 wk after the end of HCV treatment and were assumed as an outcome of the progression of psoriasis. Switching to a different b DMARD was considered as an inadequate response to biological therapy. The dropout of HCV therapy and sustained virological response(SVR) were considered as outcomes of HCV therapy.RESULTS Fifty-nine psoriatic patients in biological therapy underwent antiviral therapy for CHC. Of this, 27 patients were treated with DAAs and 32 with P/R. After 24 wk post treatment, the DLQI and the PASI scores were significantly lower(P < 0.001 and P < 0.005, respectively) in the DAAs group compared with P/R group. None of the patients in the DAAs group(0/27) compared to 8 patients of the P/R group(8/32) needed a shift in biological treatment.CONCLUSION DAAs seem to be more effective and safe than P/R in HCV-positive psoriatic patients on biological treatment. Fewer dermatological adverse events may be due to interferon-free therapy.
引文
1 Boehncke WH,Sch?n MP.Psoriasis.Lancet 2015;386:983-994[PMID:26025581 DOI:10.1016/S0140-6736(14)61909-7]
2 Psoriasis.Media resources of the American Academy of Dermatology.Available from:URL:https://www.aad.org/media/stats/conditions/psoriasis
3 Hepatitis C.Media centre of the World Health Organization;updated October 2017.Available from:URL:http://www.who.int/mediacentre/factsheets/fs164/en/
4 Viral Hepatitis.Division of Viral Hepatitis and National Center for HIV/AIDS,Viral Hepatitis,STD,and TB Prevention of the Centers for Disease Control and Prevention;updated:May 11,2017.Available from:URL:https://www.cdc.gov/hepatitis/statistics/index.htm
5 Huerta C,Rivero E,Rodríguez LA.Incidence and risk factors for psoriasis in the general population.Arch Dermatol 2007;143:1559-1565[PMID:18087008 DOI:10.1001/archderm.143.12.1559]
6 Lande R,Botti E,Jandus C,Dojcinovic D,Fanelli G,Conrad C,Chamilos G,Feldmeyer L,Marinari B,Chon S,Vence L,Riccieri V,Guillaume P,Navarini AA,Romero P,Costanzo A,Piccolella E,Gilliet M,Frasca L.Corrigendum:the antimicrobial peptide LL37is a T-cell autoantigen in psoriasis.Nat Commun 2015;6:6595[PMID:25759123 DOI:10.1038/ncomms7595]
7 Chun K,Afshar M,Audish D,Kabigting F,Paik A,Gallo R,Hata T.Hepatitis C may enhance key amplifiers of psoriasis.J Eur Acad Dermatol Venereol 2017;31:672-678[PMID:27184185 DOI:10.1111/jdv.13578]
8 Cohen AD,Weitzman D,Birkenfeld S,Dreiher J.Psoriasis associated with hepatitis C but not with hepatitis B.Dermatology2010;220:218-222[PMID:20185894 DOI:10.1159/000286131]
9 Bonifati C,Lora V,Graceffa D,Nosotti L.Management of psoriasis patients with hepatitis B or hepatitis C virus infection.World J Gastroenterol 2016;22:6444-6455[PMID:27605880DOI:10.3748/wjg.v22.i28.6444]
10 Gisondi P,Altomare G,Ayala F,Bardazzi F,Bianchi L,Chiricozzi A,Costanzo A,Conti A,Dapavo P,De Simone C,Foti C,Naldi L,Offidani A,Parodi A,Piaserico S,Prignano F,Rongioletti F,Stingeni L,Talamonti M,Girolomoni G.Italian guidelines on the systemic treatments of moderate-to-severe plaque psoriasis.J Eur Acad Dermatol Venereol 2017;31:774-790[PMID:28244153 DOI:10.1111/jdv.14114]
11 Diani M,Galasso M,Cozzi C,Sgambelluri F,Altomare A,Cigni C,Frigerio E,Drago L,Volinia S,Granucci F,Altomare G,Reali E.Blood to skin recirculation of CD4+memory T cells associates with cutaneous and systemic manifestations of psoriatic disease.Clin Immunol 2017;180:84-94[PMID:28392462 DOI:10.1016/j.clim.2017.04.001]
12 Ahn CS,Dothard EH,Garner ML,Feldman SR,Huang WW.To test or not to test?An updated evidence-based assessment of the value of screening and monitoring tests when using systemic biologic agents to treat psoriasis and psoriatic arthritis.J Am Acad Dermatol 2015;73:420-428.e1[PMID:26184440 DOI:10.1016/j.jaad.2015.06.004]
13 CraxìA,Perno CF,ViganòM,Ceccherini-Silberstein F,Petta S;Ad Hoc(Advancing Hepatitis C for the Optimization of Cure)Working Party.From current status to optimization of HCV treatment:Recommendations from an expert panel.Dig Liver Dis 2016;48:995-1005[PMID:27388261 DOI:10.1016/j.dld.2016.06.004]
14 World Health Organization.Guidelines for the screening,care and treatment of persons with chronic hepatitis C infection;updated version April 2016.Available from:URL:http://apps.who.int/iris/bitstream/10665/205035/1/9789241549615_eng.pdf?ua=1
15 Mistry N,Shapero J,Crawford RI.A review of adverse cutaneous drug reactions resulting from the use of interferon and ribavirin.Can J Gastroenterol 2009;23:677-683[PMID:19826642 DOI:10.1155/2009/651952]
16 González-Grande R,Jiménez-Pérez M,González Arjona C,Mostazo Torres J.New approaches in the treatment of hepatitis C.World J Gastroenterol 2016;22:1421-1432[PMID:26819511DOI:10.3748/wjg.v22.i4.1421]
17 Garcia-Lora E,Tercedor J,Massare E,López-Nevot MA,Skiljo M,Garcia-Mellado V.Interferon-induced psoriasis in a patient with chronic hepatitis C.Dermatology 1993;187:280[PMID:8274788DOI:10.1159/000247266]
18 Pauluzzi P,Kokelj F,Perkan V,Pozzato G,Moretti M.Psoriasis exacerbation induced by interferon-alpha.Report of two cases.Acta Derm Venereol 1993;73:395[PMID:7904414]
19 Erkek E,Karaduman A,Akcan Y,S?kmensüer C,Bükülmez G.Psoriasis associated with HCV and exacerbated by interferon alpha:complete clearance with acitretin during interferon alpha treatment for chronic active hepatitis.Dermatology 2000;201:179-181[PMID:11053930 DOI:10.1159/000018447]
20 Downs AM,Dunnill MG.Exacerbation of psoriasis by interferon-alpha therapy for hepatitis C.Clin Exp Dermatol 2000;25:351-352[PMID:10971502 DOI:10.1046/j.1365-2230.2000.00655-4.x]
21 Afshar M,Martinez AD,Gallo RL,Hata TR.Induction and exacerbation of psoriasis with Interferon-alpha therapy for hepatitis C:a review and analysis of 36 cases.J Eur Acad Dermatol Venereol 2013;27:771-778[PMID:22671985 DOI:10.1111/j.1468-3083.2012.04582.x]
22 Ahmad QM,Sameem F,Shah IH.Prevalence of hepatotrophic viruses b&c in psoriasis-A study from kashmir.Indian J Dermatol2005;50:200-202 Available from:URL:http://www.e-ijd.org/text.asp?2005/50/4/200/19744
23 Johnson-Huang LM,Suárez-Fari?as M,Pierson KC,Fuentes-Duculan J,Cueto I,Lentini T,Sullivan-Whalen M,Gilleaudeau P,Krueger JG,Haider AS,Lowes MA.A single intradermal injection of IFN-γinduces an inflammatory state in both non-lesional psoriatic and healthy skin.J Invest Dermatol 2012;132:1177-1187[PMID:22277938 DOI:10.1038/jid.2011.458]
24 Imafuku S,Naito R,Nakayama J.Possible association of hepatitis C virus infection with late-onset psoriasis:a hospital-based observational study.J Dermatol 2013;40:813-818[DOI:10.1111/1346-8138.12240]
25 Taha EA,Mekky MA,Morsy H,Saleh MA,Nafeh HM,Ez-Aldin AM,Sayed SK.Study of the impact of viral load of hepatitis C on patients with concomitant psoriasis vulgaris.Arab J Gastroenterol2014;15:98-102[PMID:25174792 DOI:10.1016/j.ajg.2014.08.001]
26 Piaserico S,Dapavo P,Conti A,Gisondi P,Russo FP.Adalimumab is a safe option for psoriasis patients with concomitant hepatitis B or C infection:a multicentre cohort study of 37 patients and review of the literature.J Eur Acad Dermatol Venereol 2017;31:1853-1859[PMID:28146345 DOI:10.1111/jdv.14146]
27 Navarro R,Vilarrasa E,Herranz P,Puig L,Bordas X,Carrascosa JM,Taberner R,Ferrán M,García-Bustinduy M,Romero-MatéA,Pedragosa R,García-Diez A,Daudén E.Safety and effectiveness of ustekinumab and antitumour necrosis factor therapy in patients with psoriasis and chronic viral hepatitis B or C:a retrospective,multicentre study in a clinical setting.Br J Dermatol 2013;168:609-616[PMID:22985451 DOI:10.1111/bjd.12045]
28 Costa L,Caso F,Atteno M,Giannitti C,Spadaro A,Ramonda R,VezzùM,Del Puente A,Morisco F,Fiocco U,Galeazzi M,Punzi L,Scarpa R.Long-term safety of anti-TNF-αin Ps A patients with concomitant HCV infection:a retrospective observational multicenter study on 15 patients.Clin Rheumatol 2014;33:273-276[PMID:23975363 DOI:10.1007/s10067-013-2378-0]
29 Salvi M,Macaluso L,Luci C,Mattozzi C,Paolino G,Aprea Y,Calvieri S,Richetta AG.Safety and efficacy of anti-tumor necrosis factorsαin patients with psoriasis and chronic hepatitis C.World JClin Cases 2016;4:49-55[PMID:26881191 DOI:10.12998/wjcc.v4.i2.49]
30 Morisco F,Guarino M,La Bella S,Di Costanzo L,Caporaso N,Ayala F,Balato N.Lack of evidence of viral reactivation in HBs Ag-negative HBc Ab-positive and HCV patients undergoing immunosuppressive therapy for psoriasis.BMC Gastroenterol 2014;14:214[PMID:25523080 DOI:10.1186/s12876-014-0214-x]
31 Burchill MA,Golden-Mason L,Wind-Rotolo M,Rosen HR.Memory re-differentiation and reduced lymphocyte activation in chronic HCV-infected patients receiving direct-acting antivirals.JViral Hepat 2015;22:983-991[PMID:26482547 DOI:10.1111/jvh.12465]
32 Spaan M,van Oord G,Kreefft K,Hou J,Hansen BE,Janssen HL,de Knegt RJ,Boonstra A.Immunological Analysis During Interferon-Free Therapy for Chronic Hepatitis C Virus Infection Reveals Modulation of the Natural Killer Cell Compartment.JInfect Dis 2016;213:216-223[PMID:26223768 DOI:10.1093/infdis/jiv391]
33 Serti E,Park H,Keane M,O’Keefe AC,Rivera E,Liang TJ,Ghany M,Rehermann B.Rapid decrease in hepatitis C viremia by direct acting antivirals improves the natural killer cell response to IFNα.Gut 2017;66:724-735[PMID:26733671 DOI:10.1136/gutjnl-2015-310033]
2 Psoriasis.Media resources of the American Academy of Dermatology.Available from:URL:https://www.aad.org/media/stats/conditions/psoriasis
3 Hepatitis C.Media centre of the World Health Organization;updated October 2017.Available from:URL:http://www.who.int/mediacentre/factsheets/fs164/en/
4 Viral Hepatitis.Division of Viral Hepatitis and National Center for HIV/AIDS,Viral Hepatitis,STD,and TB Prevention of the Centers for Disease Control and Prevention;updated:May 11,2017.Available from:URL:https://www.cdc.gov/hepatitis/statistics/index.htm
5 Huerta C,Rivero E,Rodríguez LA.Incidence and risk factors for psoriasis in the general population.Arch Dermatol 2007;143:1559-1565[PMID:18087008 DOI:10.1001/archderm.143.12.1559]
6 Lande R,Botti E,Jandus C,Dojcinovic D,Fanelli G,Conrad C,Chamilos G,Feldmeyer L,Marinari B,Chon S,Vence L,Riccieri V,Guillaume P,Navarini AA,Romero P,Costanzo A,Piccolella E,Gilliet M,Frasca L.Corrigendum:the antimicrobial peptide LL37is a T-cell autoantigen in psoriasis.Nat Commun 2015;6:6595[PMID:25759123 DOI:10.1038/ncomms7595]
7 Chun K,Afshar M,Audish D,Kabigting F,Paik A,Gallo R,Hata T.Hepatitis C may enhance key amplifiers of psoriasis.J Eur Acad Dermatol Venereol 2017;31:672-678[PMID:27184185 DOI:10.1111/jdv.13578]
8 Cohen AD,Weitzman D,Birkenfeld S,Dreiher J.Psoriasis associated with hepatitis C but not with hepatitis B.Dermatology2010;220:218-222[PMID:20185894 DOI:10.1159/000286131]
9 Bonifati C,Lora V,Graceffa D,Nosotti L.Management of psoriasis patients with hepatitis B or hepatitis C virus infection.World J Gastroenterol 2016;22:6444-6455[PMID:27605880DOI:10.3748/wjg.v22.i28.6444]
10 Gisondi P,Altomare G,Ayala F,Bardazzi F,Bianchi L,Chiricozzi A,Costanzo A,Conti A,Dapavo P,De Simone C,Foti C,Naldi L,Offidani A,Parodi A,Piaserico S,Prignano F,Rongioletti F,Stingeni L,Talamonti M,Girolomoni G.Italian guidelines on the systemic treatments of moderate-to-severe plaque psoriasis.J Eur Acad Dermatol Venereol 2017;31:774-790[PMID:28244153 DOI:10.1111/jdv.14114]
11 Diani M,Galasso M,Cozzi C,Sgambelluri F,Altomare A,Cigni C,Frigerio E,Drago L,Volinia S,Granucci F,Altomare G,Reali E.Blood to skin recirculation of CD4+memory T cells associates with cutaneous and systemic manifestations of psoriatic disease.Clin Immunol 2017;180:84-94[PMID:28392462 DOI:10.1016/j.clim.2017.04.001]
12 Ahn CS,Dothard EH,Garner ML,Feldman SR,Huang WW.To test or not to test?An updated evidence-based assessment of the value of screening and monitoring tests when using systemic biologic agents to treat psoriasis and psoriatic arthritis.J Am Acad Dermatol 2015;73:420-428.e1[PMID:26184440 DOI:10.1016/j.jaad.2015.06.004]
13 CraxìA,Perno CF,ViganòM,Ceccherini-Silberstein F,Petta S;Ad Hoc(Advancing Hepatitis C for the Optimization of Cure)Working Party.From current status to optimization of HCV treatment:Recommendations from an expert panel.Dig Liver Dis 2016;48:995-1005[PMID:27388261 DOI:10.1016/j.dld.2016.06.004]
14 World Health Organization.Guidelines for the screening,care and treatment of persons with chronic hepatitis C infection;updated version April 2016.Available from:URL:http://apps.who.int/iris/bitstream/10665/205035/1/9789241549615_eng.pdf?ua=1
15 Mistry N,Shapero J,Crawford RI.A review of adverse cutaneous drug reactions resulting from the use of interferon and ribavirin.Can J Gastroenterol 2009;23:677-683[PMID:19826642 DOI:10.1155/2009/651952]
16 González-Grande R,Jiménez-Pérez M,González Arjona C,Mostazo Torres J.New approaches in the treatment of hepatitis C.World J Gastroenterol 2016;22:1421-1432[PMID:26819511DOI:10.3748/wjg.v22.i4.1421]
17 Garcia-Lora E,Tercedor J,Massare E,López-Nevot MA,Skiljo M,Garcia-Mellado V.Interferon-induced psoriasis in a patient with chronic hepatitis C.Dermatology 1993;187:280[PMID:8274788DOI:10.1159/000247266]
18 Pauluzzi P,Kokelj F,Perkan V,Pozzato G,Moretti M.Psoriasis exacerbation induced by interferon-alpha.Report of two cases.Acta Derm Venereol 1993;73:395[PMID:7904414]
19 Erkek E,Karaduman A,Akcan Y,S?kmensüer C,Bükülmez G.Psoriasis associated with HCV and exacerbated by interferon alpha:complete clearance with acitretin during interferon alpha treatment for chronic active hepatitis.Dermatology 2000;201:179-181[PMID:11053930 DOI:10.1159/000018447]
20 Downs AM,Dunnill MG.Exacerbation of psoriasis by interferon-alpha therapy for hepatitis C.Clin Exp Dermatol 2000;25:351-352[PMID:10971502 DOI:10.1046/j.1365-2230.2000.00655-4.x]
21 Afshar M,Martinez AD,Gallo RL,Hata TR.Induction and exacerbation of psoriasis with Interferon-alpha therapy for hepatitis C:a review and analysis of 36 cases.J Eur Acad Dermatol Venereol 2013;27:771-778[PMID:22671985 DOI:10.1111/j.1468-3083.2012.04582.x]
22 Ahmad QM,Sameem F,Shah IH.Prevalence of hepatotrophic viruses b&c in psoriasis-A study from kashmir.Indian J Dermatol2005;50:200-202 Available from:URL:http://www.e-ijd.org/text.asp?2005/50/4/200/19744
23 Johnson-Huang LM,Suárez-Fari?as M,Pierson KC,Fuentes-Duculan J,Cueto I,Lentini T,Sullivan-Whalen M,Gilleaudeau P,Krueger JG,Haider AS,Lowes MA.A single intradermal injection of IFN-γinduces an inflammatory state in both non-lesional psoriatic and healthy skin.J Invest Dermatol 2012;132:1177-1187[PMID:22277938 DOI:10.1038/jid.2011.458]
24 Imafuku S,Naito R,Nakayama J.Possible association of hepatitis C virus infection with late-onset psoriasis:a hospital-based observational study.J Dermatol 2013;40:813-818[DOI:10.1111/1346-8138.12240]
25 Taha EA,Mekky MA,Morsy H,Saleh MA,Nafeh HM,Ez-Aldin AM,Sayed SK.Study of the impact of viral load of hepatitis C on patients with concomitant psoriasis vulgaris.Arab J Gastroenterol2014;15:98-102[PMID:25174792 DOI:10.1016/j.ajg.2014.08.001]
26 Piaserico S,Dapavo P,Conti A,Gisondi P,Russo FP.Adalimumab is a safe option for psoriasis patients with concomitant hepatitis B or C infection:a multicentre cohort study of 37 patients and review of the literature.J Eur Acad Dermatol Venereol 2017;31:1853-1859[PMID:28146345 DOI:10.1111/jdv.14146]
27 Navarro R,Vilarrasa E,Herranz P,Puig L,Bordas X,Carrascosa JM,Taberner R,Ferrán M,García-Bustinduy M,Romero-MatéA,Pedragosa R,García-Diez A,Daudén E.Safety and effectiveness of ustekinumab and antitumour necrosis factor therapy in patients with psoriasis and chronic viral hepatitis B or C:a retrospective,multicentre study in a clinical setting.Br J Dermatol 2013;168:609-616[PMID:22985451 DOI:10.1111/bjd.12045]
28 Costa L,Caso F,Atteno M,Giannitti C,Spadaro A,Ramonda R,VezzùM,Del Puente A,Morisco F,Fiocco U,Galeazzi M,Punzi L,Scarpa R.Long-term safety of anti-TNF-αin Ps A patients with concomitant HCV infection:a retrospective observational multicenter study on 15 patients.Clin Rheumatol 2014;33:273-276[PMID:23975363 DOI:10.1007/s10067-013-2378-0]
29 Salvi M,Macaluso L,Luci C,Mattozzi C,Paolino G,Aprea Y,Calvieri S,Richetta AG.Safety and efficacy of anti-tumor necrosis factorsαin patients with psoriasis and chronic hepatitis C.World JClin Cases 2016;4:49-55[PMID:26881191 DOI:10.12998/wjcc.v4.i2.49]
30 Morisco F,Guarino M,La Bella S,Di Costanzo L,Caporaso N,Ayala F,Balato N.Lack of evidence of viral reactivation in HBs Ag-negative HBc Ab-positive and HCV patients undergoing immunosuppressive therapy for psoriasis.BMC Gastroenterol 2014;14:214[PMID:25523080 DOI:10.1186/s12876-014-0214-x]
31 Burchill MA,Golden-Mason L,Wind-Rotolo M,Rosen HR.Memory re-differentiation and reduced lymphocyte activation in chronic HCV-infected patients receiving direct-acting antivirals.JViral Hepat 2015;22:983-991[PMID:26482547 DOI:10.1111/jvh.12465]
32 Spaan M,van Oord G,Kreefft K,Hou J,Hansen BE,Janssen HL,de Knegt RJ,Boonstra A.Immunological Analysis During Interferon-Free Therapy for Chronic Hepatitis C Virus Infection Reveals Modulation of the Natural Killer Cell Compartment.JInfect Dis 2016;213:216-223[PMID:26223768 DOI:10.1093/infdis/jiv391]
33 Serti E,Park H,Keane M,O’Keefe AC,Rivera E,Liang TJ,Ghany M,Rehermann B.Rapid decrease in hepatitis C viremia by direct acting antivirals improves the natural killer cell response to IFNα.Gut 2017;66:724-735[PMID:26733671 DOI:10.1136/gutjnl-2015-310033]