The addition of a protease inhibitor increases the risk of infections in patients with hepatitis C-related cirrhosis

Published:October 01, 2014DOI:

      Background & Aims

      Antiviral therapy with interferon and ribavirin (double therapy) is associated with a significant risk of developing bacterial infections in patients with hepatitis C-related cirrhosis. The addition of telaprevir or boceprevir seems to increase this risk but there are no studies yet to compare the infection rate between both treatments. We aimed to assess rate, type and predictive factors of infection in cirrhotic patients undergoing triple or double antiviral therapy.


      This was a retrospective analysis of prospectively collected data. 167 patients with hepatitis C-related cirrhosis undergoing triple therapy (cohort A) and 81 receiving double therapy (cohort B) were enrolled in the study. Only Child-Pugh A patients were included.


      The infection rate was significantly higher for patients in cohort A as compared to those in cohort B (25% vs. 9%, p = 0.001). Interestingly, respiratory tract infections were significantly more frequent in patients in cohort A (12% vs. 1%; p = 0.049). The use of triple antiviral therapy was the only predictive factor of infection. Severe infections were also more frequent in patients in cohort A, but the difference did not reach the level of significance (13% vs. 6%, p = 0.123).


      Triple therapy carries a higher risk of infections in patients with cirrhosis and changes the pattern of infection in this subpopulation. Further studies are needed in order to establish the underlying mechanism of this event.

      Graphical abstract


      HCV (hepatitis C), LT (liver transplantation), SBP (spontaneous bacterial peritonitis), SB (spontaneous bacteraemia), SVR (sustained virological response), CUPIC (compassionate use of protease inhibitors in viral C cirrhosis), HVPG (hepatic venous gradient pressure), SVR (sustained virological response), GMSF (granulocyte-monocyte stimulating factor), OR (odds ratio), GU (genitourinary), GI (gastrointestinal), NOD2 (nucleotide-binding oligomerization domain-containing protein 2), TLR2 (toll-like receptor 2), NSP (neutrophil serine proteases), NE (neutrophil elastase)


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