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Gastroenterology. 2017 Jan;152(1):142-156.e2. doi: 10.1053/j.gastro.2016.09.009. Epub 2016 Sep 15.

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

Author information

1
AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Université Paris 13, Sorbonne Paris Cité, "Equipe Labellisée Ligue Contre le Cancer," Saint-Denis, France; Inserm, UMR-1162, "Génomique Fonctionnelle des Tumeur Solides," Paris, France. Electronic address: pierre.nahon@jvr.aphp.fr.
2
AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France.
3
AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, Ageing-Thorax-Vessels-Blood Département Hospitalo-Universitaire, Clinical Epidemiology and Aging Unit, Université Paris-Est Créteil, Créteil, France.
4
Unit for Basic and Clinical Research on Viral Hepatitis, Association Nationale pour la Recherche sur le SIDA et les hépatites virales (ANRS), France REcherche Nord and sud Sida-HIV Hépatites, Paris, France.
5
AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France.
6
Centre Hospitalo-Universitaire Pontchaillou, Service d'Hépatologie, Rennes, France.
7
AP-HP, Hôpital Cochin, Département d'Hépatologie, France.
8
Hôpital Saint Eloi, Service d'Hépatologie, Montpellier, France.
9
Hôpital Haut-Lévêque, Service d'Hépatologie, Bordeaux, France.
10
Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France.
11
Hospices Civils de Lyon, Service d'Hépatologie et Université de Lyon, Lyon, France.
12
AP-HP, Hôpital Avicenne, Service d'Hépatologie, Bobigny, France.
13
Centre Hospitalo-Universitaire de Nice, Service d'Hépatologie, Nice, France; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity," Nice, France.
14
Inserm 954, Centre Hospitalo-Universitaire de Nancy, Université de Lorraine, Vandoeuvre-les-Nancy, France.
15
Hôpital Michallon, Service d'Hépatologie, Grenoble, France.
16
Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France.
17
Centre Hospitalo-Universitaire d'Angers, Service d'Hépato-Gastroentérologie, Angers, France.
18
Hôpital Purpan, Service d'Hépatologie, Toulouse, France.
19
Centre Hospitalo-Universitaire Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France.
20
Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France.
21
Hôpital Claude Huriez, Service d'Hépatologie, Lille, France.
22
Hôpital St André, Service d'Hépatologie, Bordeaux, France.
23
Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France.
24
AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France.
25
AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France.
26
AP-HP, Hôpital Tenon, Service d'Hépatologie, Paris, France.
27
AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France.
28
Hôpital Trousseau, Unité d'Hépatologie, Centre Hospitalier Régional Universitaire de Tours, France.
29
Hôpital d'Aix-en-Provence, Service d'Hépatologie, Aix-En-Provence, France.
30
Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France.
31
AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France.
32
Centre Hospitalo-Universitaire Le Mans, Service d'Hépatologie, Le Mans, France.
33
Centre Hospitalo-Universitaire de Poitiers, Service d'Hépatologie, Poitiers, France.
34
Institut Mutualiste Montsouris, Service d'Hépatologie, Paris, France.
35
Hôpital Amiens Nord, Service d'Hépatologie, Amiens, France.
36
Hôpital Robert Debré, Service d'Hépatologie, Reims, France.
37
Hôpital Foch, Service de Médecine Interne, Suresnes, France.
38
Hôpital Jean Minjoz, Service d'Hépatologie, Besançon, France.
39
Centre Hospitalo-Universitaire Pontchaillou, Service de Virologie, Rennes, France.
40
AP-HP, Hôpital Cochin, Service de Maladies Infectieuses, Université Paris Descartes, Paris, France.
41
Université Paris 13, Sorbonne Paris Cité, "Equipe Labellisée Ligue Contre le Cancer," Saint-Denis, France; Inserm, UMR-1162, "Génomique Fonctionnelle des Tumeur Solides," Paris, France; AP-HP, Hôpital Jean Verdier, Service d'Anatomopathologie, Bondy, France; Centre de Ressources Biologiques (Liver Disease Biobank) Groupe Hospitalier Paris, Seine-Saint-Denis, France.
42
Centre de Ressources Biologiques (Liver Disease Biobank) Groupe Hospitalier Paris, Seine-Saint-Denis, France; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy, France; Inserm U1148, Université Paris 13, Bobigny, France.
43
AP-HP, Hôpital Cochin, Département d'Hépatologie, France; Inserm UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris, France.

Erratum in

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

PMID:
27641509
DOI:
10.1053/j.gastro.2016.09.009
[Indexed for MEDLINE]

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