Eradication of Hepatitis C Virus Infection in Patients With Cirrhosis Reduces Risk of Liver and Non-Liver Complications

Pierre Nahon 1, 2 Valérie Bourcier 1 Richard Layese Etienne Audureau Carole Cagnot Patrick Marcellin 3 Dominique Guyader 4 Hélène Fontaine 5 Dominique Larrey 6, 7 Victor De Ledinghen 8 Denis Ouzan Fabien Zoulim 9 Dominique Roulot 10 Albert Tran 11 Jean-Pierre Bronowicki 12, 13 Jean-Pierre Zarski 14, 15 Vincent Leroy 16 Ghassan Riachi 17 Paul Calès 18 Jean-Marie Peron 19 Laurent Alric 20 Marc Bourlière 21, 22 Philippe Mathurin 23 Sébastien Dharancy 24 Jean-Frederic Blanc 25, 26 Armand Abergel 27 Lawrence Serfaty 28 Ariane Mallat 29, 30 Jean-Didier Grangé Pierre Attali 31 Yannick Bacq 32 Claire Wartelle Thong Dao 33, 34 Yves Benhamou 35 Christophe Pilette Christine Silvain 36 Christos Christidis Dominique Capron 37 Brigitte Bernard-Chabert David Zucman 38 Vincent Di Martino 39 Vincent Thibaut 40 Dominique Salmon 41, 42, 43 Marianne Ziol 44, 2 Angela Sutton 45, 46 Stanislas Pol 47, 48 Françoise Roudot-Thoraval 49
Abstract : BACKGROUND & AIMS: We performed a prospective study to investigate the effects of a sustained viral response (SVR) on outcomes of patients with hepatitis C virus (HCV) infection and compensated cirrhosis. METHODS: We collected data from 1323 patients included in the prospective Agence Nationale pour la Recherche sur le SIDA et les hépatites virales (ANRS) viral cirrhosis (CirVir) cohort, recruited from 35 clinical centers in France from 2006 through 2012. All patients had HCV infection and biopsy-proven cirrhosis, were Child-Pugh class A, and had no prior liver complications. All patients received anti-HCV treatment before or after inclusion (with interferon then with direct antiviral agents) and underwent an ultrasound examination every 6 months, as well as endoscopic evaluations. SVR was considered as a time-dependent covariate; its effect on outcome was assessed by the Cox proportional hazard regression method. We used a propensity score to minimize confounding by indication of treatment and capacity to achieve SVR. RESULTS: After a median follow-up period of 58.2 months, 668 patients (50.5%) achieved SVR. SVR was associated with a decreased incidence of hepatocellular carcinoma (hazard ratio [HR] compared with patients without an SVR, 0.29; 95% confidence interval [CI], 0.19-0.43; P < .001) and hepatic decompensation (HR, 0.26; 95% CI, 0.17-0.39; P < .001). Patients with SVRs also had a lower risk of cardiovascular events (HR, 0.42; 95% CI, 0.25-0.69; P = .001) and bacterial infections (HR, 0.44; 95% CI, 0.29-0.68; P < .001). Metabolic features were associated with a higher risk of hepatocellular carcinoma in patients with SVRs, but not in patients with viremia. SVR affected overall mortality (HR, 0.27 compared with patients without SVR; 95% CI, 0.18-0.42; P < .001) and death from liver-related and non-liver-related causes. Similar results were obtained in a propensity score-matched population. CONCLUSIONS: We confirmed a reduction in critical events, liver-related or not, in a prospective study of patients with HCV infection and compensated cirrhosis included in the CirVir cohort who achieved an SVR. We found an SVR to reduce overall mortality and risk of death from liver-related and non-liver-related causes. A longer follow-up evaluation is required to accurately describe and assess specific risk factors for complications in this population.
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Gastroenterology, 2017, 152, pp.142-156.e2. <10.1053/j.gastro.2016.09.009>
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Soumis le : jeudi 26 janvier 2017 - 15:29:11
Dernière modification le : vendredi 28 juillet 2017 - 01:09:50

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Pierre Nahon, Valérie Bourcier, Richard Layese, Etienne Audureau, Carole Cagnot, et al.. Eradication of Hepatitis C Virus Infection in Patients With Cirrhosis Reduces Risk of Liver and Non-Liver Complications. Gastroenterology, 2017, 152, pp.142-156.e2. <10.1053/j.gastro.2016.09.009>. <hal-01447065>

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