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

Pierre Nahon; Valérie Bourcier; Richard Layese; Etienne Audureau; Carole Cagnot; Patrick Marcellin; Dominique Guyader; Hélène Fontaine; Dominique Larrey; Victor de Ledinghen; Denis Ouzan; Fabien Zoulim; Dominique Roulot; Albert Tran; Jean-Pierre Bronowicki; Jean-Pierre Zarski; Vincent Leroy; Ghassan Riachi; Paul Calès; Jean-Marie Peron; Laurent Alric; Marc Bourlière; Philippe Mathurin; Sébastien Dharancy; Jean-Frederic Blanc; Armand Abergel; Lawrence Serfaty; Ariane Mallat; Jean-Didier Grangé; Pierre Attali; Yannick Bacq; Claire Wartelle; Thong Dao; Yves Benhamou; Christophe Pilette; Christine Silvain; Christos Christidis; Dominique Capron; Brigitte Bernard-Chabert; David Zucman; Vincent Di Martino; Vincent Thibaut; Dominique Salmon; Marianne Ziol; Angela Sutton; Stanislas Pol; Françoise Roudot-Thoraval

doi:10.1053/j.gastro.2016.09.009

Journal articles

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

1 Service d'Hépato-gastroentérologie

2 U1162 - Génomique Fonctionnelle des Tumeurs Solides

3 Service d’Hépatologie [Hôpital Beaujon]

4 Foie, métabolismes et cancer

5 Department of hepatology

6 CHU Saint-Eloi

7 Cellules souches normales et cancéreuses

8 Physiopathologie du cancer du foie

9 Centre de Recherche sur le Cancer de Lyon

10 Service de Gastro-entérologie [Avicenne]

11 C3M - Centre méditerranéen de médecine moléculaire

12 Service d'Hépato-gastro-entérologie [CHRU Nancy]

13 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux

14 Département d'hépato-gastroentérologie

15 INSERM U823 - Institut d'oncologie/développement Albert Bonniot de Grenoble

16 SLIDE - ScaLable Information Discovery and Exploitation [Saint Martin d’Hères]

LIG - Laboratoire d'Informatique de Grenoble [2007-2015]

17 Service d'Hépato-Gastroentérologie [CHU Rouen]

18 HIFIH - Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques

19 Hepato-gastro-enterology

20 IRSD - Institut de Recherche en Santé Digestive

21 Service d'hépato-gastro-entérologie

22 Hôpital Saint-Joseph [Marseille]

23 Service d'Hépato-gastroentérologie

24 Service d'hépatologie

25 Inserm, UMR-1053; Université de Bordeaux, Bordeaux, F-33076, France

26 Centre hospitalier universitaire de Bordeaux, Department of Hepatology, Hôpital Saint-André, Bordeaux, F-33076, France

27 Service d'Hépato-Gastro-Entérologie

28 CHU Saint-Antoine [APHP]

29 IMRB - Institut Mondor de Recherche Biomédicale

30 Service d'hépato-gastro-entérologie [APHP Henri Mondor]

31 Hôpital Paul Brousse

32 Service de gastro-entérologie [CHU Trousseau]

33 Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen]

34 COMETE - Mobilités : Vieillissement, Pathologie, Santé

35 Service d'Hépato-Gastroentérologie [CHU Pitié-Salpêtrière]

36 Hôpital de la Milétrie

37 Service d'Hépatogastroentérologie

38 Med Int - Hôpital Foch - Service de Médecine Interne

39 Service d'hépatologie

40 CHU Pontchaillou [Rennes]

41 UPD5 - Université Paris Descartes - Paris 5

42 Service de médecine interne et centre de référence des maladies rares [CHU Cochin]

43 FHDH-ANRS CO4

44 Service d'anatomie pathologique

45 Hôpital Jean Verdier AP-HP Bondy

46 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle

47 Service d'hépatologie médicale [CHU Cochin]

48 Immunobiologie des Cellules dendritiques

49 Service de santé publique [Mondor]

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.

Keywords : ANRS CirVir Direct Antivirals HCV Clearance Prognosis

Document type :

Journal articles

Domain :

Life Sciences [q-bio] / Cancer

Life Sciences [q-bio] / Human health and pathology / Hépatology and Gastroenterology

Complete list of metadatas

https://hal-univ-rennes1.archives-ouvertes.fr/hal-01447065
Contributor : Laurent Jonchère <>
Submitted on : Thursday, January 26, 2017 - 3:29:11 PM
Last modification on : Friday, July 3, 2020 - 4:52:48 PM

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

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

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