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

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 152; no. 1; pp. 142 - 156.e2
• Main Authors: Nahon, Pierre, Bourcier, Valérie, Layese, Richard, Audureau, Etienne, Cagnot, Carole, Marcellin, Patrick, Guyader, Dominique, Fontaine, Hélène, Larrey, Dominique, De Lédinghen, Victor, Ouzan, Denis, Zoulim, Fabien, Roulot, Dominique, Tran, Albert, Bronowicki, Jean-Pierre, Zarski, Jean-Pierre, Leroy, Vincent, Riachi, Ghassan, Calès, Paul, Péron, Jean-Marie, Alric, Laurent, Bourlière, Marc, Mathurin, Philippe, Dharancy, Sébastien, Blanc, Jean-Frédéric, Abergel, Armand, Serfaty, Lawrence, Mallat, Ariane, Grangé, Jean-Didier, Attali, Pierre, Bacq, Yannick, Wartelle, Claire, Dao, Thông, Benhamou, Yves, Pilette, Christophe, Silvain, Christine, Christidis, Christos, Capron, Dominique, Bernard-Chabert, Brigitte, Zucman, David, Di Martino, Vincent, Thibaut, Vincent, Salmon, Dominique, Ziol, Marianne, Sutton, Angela, Pol, Stanislas, Roudot-Thoraval, Françoise
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2017; Elsevier
• Subjects: Aged; ANRS CirVir; Antiviral Agents - therapeutic use; Aspartate Aminotransferases - blood; Bacterial Infections - epidemiology; Body Mass Index; Cancer; Carcinoma, Hepatocellular - epidemiology; Carcinoma, Hepatocellular - mortality; Cardiovascular Diseases - epidemiology; Diabetes Mellitus - epidemiology; Direct Antivirals; Dyslipidemias - epidemiology; Female; Follow-Up Studies; France - epidemiology; gamma-Glutamyltransferase - blood; Gastroenterology and Hepatology; HCV Clearance; Hepatitis C - complications; Hepatitis C - drug therapy; Hepatitis C - mortality; Human health and pathology; Humans; Hépatology and Gastroenterology; Incidence; Life Sciences; Liver Cirrhosis - complications; Liver Cirrhosis - mortality; Liver Cirrhosis - physiopathology; Liver Neoplasms - epidemiology; Liver Neoplasms - mortality; Male; Metabolic Syndrome - epidemiology; Middle Aged; Platelet Count; Prognosis; Prospective Studies; Prothrombin Time; Sustained Virologic Response; major adverse cardiac event; Prognosis; ultrasonography; HCV Clearance; PLC; Agence Nationale pour la Recherche sur le SIDA et les hépatites virales cohort 12 viral cirrhosis; BI; HR; AFP; interquartile range; missing data; SVR; IFN; peg-interferon; cumulated incidence; MACE; MD; hepatitis C virus; α-fetoprotein; ANRS CO12 CirVir; sustained virologic response; hepatocellular carcinoma; primary liver cancer; US; SBP; ribavirin; Direct Antivirals; DAA; RBV; HCC; IQR; bacterial infection; interferon; CumI; direct antiviral agent; ANRS CirVir; hazard ratio; HCV; Peg-IFN; spontaneous bacterial peritonitis
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1053/j.gastro.2016.09.009

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.