title: The addition of a protease inhibitor increases the risk of infections in patients with hepatitis C-related cirrhosis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Liver Unit, Hospital Clínic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain. Electronic address: mlondono@clinic.ub.es.
authors.forename: Maria-Carlota
authors.initials: MC
authors.lastname: Londoño
authors.affiliation: Gastroenterology and Hepatology Service, Hospital Universitario de Puerta de Hierro-Majadahonda, IDIPHIM, CIBERehd, Madrid, Spain.
authors.forename: Christie
authors.initials: C
authors.lastname: Perelló
authors.affiliation: Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla and Marqués de Valdecilla Research Institute (IDIVAL), Santander, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Cabezas
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Cañete
authors.affiliation: Liver Unit, Hospital Clínic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Sabela
authors.initials: S
authors.lastname: Lens
authors.affiliation: Liver Unit, Hospital Clínic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Mariño
authors.affiliation: Liver Unit, Hospital Clínic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Martina
authors.initials: M
authors.lastname: Gambato
authors.affiliation: Gastroenterology and Hepatology Service, Hospital Universitario de Puerta de Hierro-Majadahonda, IDIPHIM, CIBERehd, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Rodríguez
authors.affiliation: Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla and Marqués de Valdecilla Research Institute (IDIVAL), Santander, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Menéndez
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Carrión
authors.affiliation: Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla and Marqués de Valdecilla Research Institute (IDIVAL), Santander, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Crespo
authors.affiliation: Gastroenterology and Hepatology Service, Hospital Universitario de Puerta de Hierro-Majadahonda, IDIPHIM, CIBERehd, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Calleja
authors.affiliation: Liver Unit, Hospital Clínic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Forns
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000453:epidemiology* / Q000209:etiology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011480:Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012367:RNA, Viral / Q000235:genetics*; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D011480:Protease Inhibitors; D012367:RNA, Viral
keywords: Cirrhosis; Infections; Triple therapy