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 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

1 Service d'Hépato-gastroentérologie

2 U1162 - Génomique Fonctionnelle des Tumeurs Solides

3 AP-HP - Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris

4 ANRS - Agence Nationale de Recherches sur le Sida et les Hépatites Virales

5 Service d’Hépatologie [Hôpital Beaujon]

6 Foie, métabolismes et cancer

7 Department of hepatology

8 CHU Saint-Eloi

9 Cellules souches normales et cancéreuses

10 Physiopathologie du cancer du foie

11 Institut Arnault Tzanck

12 Centre de Recherche sur le Cancer de Lyon

13 Service de Gastro-entérologie [Avicenne]

14 C3M - Centre méditerranéen de médecine moléculaire

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

16 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux

17 Département d'hépato-gastroentérologie

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

19 SLIDE - ScaLable Information Discovery and Exploitation [Grenoble]

LIG - Laboratoire d'Informatique de Grenoble

20 Service d'Hépato-Gastroentérologie [CHU Rouen]

21 HIFIH - Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques

22 Hôpital Purpan [Toulouse]

23 PHARMA-DEV - Pharmacochimie et Biologie pour le Développement

24 Service d'hépato-gastro-entérologie

25 Hôpital Saint-Joseph [Marseille]

26 Service d'Hépato-gastroentérologie

27 Service d'hépatologie

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

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

30 Service d'Hépato-Gastro-Entérologie

31 CHU Saint-Antoine [AP-HP]

32 IMRB - Institut Mondor de Recherche Biomédicale

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

34 AP-HP Hôpital Tenon [Paris]

35 Hôpital Paul Brousse

36 Service de gastro-entérologie [CHU Trousseau]

37 Hopital d'Aix en Provence

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

39 COMETE - Mobilités : Vieillissement, Pathologie, Santé

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

41 CHU Le MAns

42 Hôpital de la Milétrie

43 IMM - Institut Mutualiste de Montsouris

44 Service d'Hépatogastroentérologie

45 Hôpital Robert Debré

46 Med Int - Hôpital Foch - Service de Médecine Interne

47 Service d'hépatologie

48 CHU Pontchaillou [Rennes]

49 UPD5 - Université Paris Descartes - Paris 5

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

51 FHDH-ANRS CO4

52 Service d'anatomie pathologique

53 Hôpital Jean Verdier [AP-HP]

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

55 Service d'hépatologie médicale [CHU Cochin]

56 Immunobiologie des Cellules dendritiques

57 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

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https://hal-univ-rennes1.archives-ouvertes.fr/hal-01447065
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Submitted on : Thursday, January 26, 2017 - 3:29:11 PM
Last modification on : Friday, July 2, 2021 - 3:32:59 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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