Eradication of HCV infection in patients With cirrhosis reduces risk of liver and non-liver complications
In this prospective study patients with cirrhosis treated with interferon-based therapy or interferon-free regimens who achieved sustained virologic response (SVR) reduced; overall mortality and risk of death from liver-related and non–liver-related causes.......
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Abstract
Eradication of Hepatitis C Virus Infection in Patients With Cirrhosis Reduces Risk of Liver and Non-Liver Complications
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.
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 ANRS 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 direct antiviral agents) and underwent 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.
We collected data from 1323 patients included in the prospective ANRS 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 direct antiviral agents) and underwent 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 an SVR. SVR was associated with a decreased incidence of hepatocellular carcinoma (HCC; hazard ratio [HR] compared to patients without an SVR=0.29; 95% 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 higher risk of HCC in patients with SVRs, but not in patients with viremia. SVR affected overall mortality (HR=0.27 compared to 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.
After a median follow-up period of 58.2 months, 668 patients (50.5%) achieved an SVR. SVR was associated with a decreased incidence of hepatocellular carcinoma (HCC; hazard ratio [HR] compared to patients without an SVR=0.29; 95% 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 higher risk of HCC in patients with SVRs, but not in patients with viremia. SVR affected overall mortality (HR=0.27 compared to 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 is required to accurately describe and assess specific risk factors for complications in this population.
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 is required to accurately describe and assess specific risk factors for complications in this population.
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