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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 2 Richard Layese 3 Etienne Audureau 3 Carole Cagnot 4 Patrick Marcellin 5 Dominique Guyader 6 Hélène Fontaine 7 Dominique Larrey 8, 9, 10 Victor de Ledinghen 11 Denis Ouzan 12 Fabien Zoulim 13 Dominique Roulot 14 Albert Tran 15 Jean-Pierre Bronowicki 16, 17 Jean-Pierre Zarski 18, 19 Vincent Leroy 20 Ghassan Riachi 21 Paul Calès 22 Jean-Marie Peron 23 Laurent Alric 24 Marc Bourlière 25 Philippe Mathurin 26 Sébastien Dharancy 26 Jean-Frederic Blanc 27 Armand Abergel 28 Lawrence Serfaty 29 Ariane Mallat 30, 31 Jean-Didier Grangé 32 Pierre Attali 33 Yannick Bacq 34 Claire Wartelle 35 Thong Dao 36, 37 Yves Benhamou 38 Christophe Pilette 39 Christine Silvain 40 Christos Christidis 41 Dominique Capron 42 Brigitte Bernard-Chabert 43 David Zucman 44 Vincent Di Martino 45 Vincent Thibaut 46 Dominique Salmon 47, 48, 49 Marianne Ziol 1, 2 Angela Sutton 2, 50 Stanislas Pol 51, 52 Françoise Roudot-Thoraval 53 
* Corresponding author
20 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 : Monday, November 14, 2022 - 1:44:05 AM

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

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