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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 3 Etienne Audureau 3 Carole Cagnot 4 Patrick Marcellin 5 Dominique Guyader 6 Hélène Fontaine 7 Dominique Larrey 8, 9 Victor de Ledinghen 10 Denis Ouzan 11 Fabien Zoulim 12 Dominique Roulot 13 Albert Tran 14 Jean-Pierre Bronowicki 15, 16 Jean-Pierre Zarski 17, 18 Vincent Leroy 19 Ghassan Riachi 20 Paul Calès 21 Jean-Marie Peron 22 Laurent Alric 23 Marc Bourlière 24, 25 Philippe Mathurin 26 Sébastien Dharancy 27 Jean-Frederic Blanc 28, 29 Armand Abergel 30 Lawrence Serfaty 31 Ariane Mallat 32, 33 Jean-Didier Grangé 34 Pierre Attali 35 Yannick Bacq 36 Claire Wartelle 37 Thong Dao 38, 39 Yves Benhamou 40 Christophe Pilette 41 Christine Silvain 42 Christos Christidis 43 Dominique Capron 44 Brigitte Bernard-Chabert 45 David Zucman 46 Vincent Di Martino 47 Vincent Thibaut 48 Dominique Salmon 49, 50, 51 Marianne Ziol 52, 2 Angela Sutton 53, 54 Stanislas Pol 55, 56 Françoise Roudot-Thoraval 57
* Corresponding author
19 SLIDE - ScaLable Information Discovery and Exploitation [Grenoble]
LIG - Laboratoire d'Informatique de Grenoble
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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Submitted on : Thursday, January 26, 2017 - 3:29:11 PM
Last modification on : Wednesday, December 1, 2021 - 6:20:01 PM

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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, WB Saunders, 2017, 152 (1), pp.142-156.e2. ⟨10.1053/j.gastro.2016.09.009⟩. ⟨hal-01447065⟩

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