Eradication of Hepatitis C Virus Infection in Patients With Cirrhosis Reduces Risk of Liver and Non-Liver Complications - Université de Rennes Accéder directement au contenu
Article Dans Une Revue Gastroenterology Année : 2017

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

1 U1162 - Génomique Fonctionnelle des Tumeurs Solides
2 Hôpital Jean Verdier [AP-HP]
3 Hôpital Henri Mondor
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 Hôpital Cochin [AP-HP]
8 Cellules souches normales et cancéreuses
9 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
10 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
11 Physiopathologie du cancer du foie
12 Institut Arnault Tzanck
13 HCL - Hospices Civils de Lyon
14 Service de Gastro-entérologie [Avicenne]
15 C3M - Centre méditerranéen de médecine moléculaire
16 Service d'Hépato-gastro-entérologie [CHRU Nancy]
17 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux
18 Département d'hépato-gastroentérologie
19 INSERM U823 - Institut d'oncologie/développement Albert Bonniot de Grenoble
20 SLIDE - ScaLable Information Discovery and Exploitation [Grenoble]
21 Service d'Hépato-Gastroentérologie [CHU Rouen]
22 HIFIH - Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques
23 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
24 PHARMA-DEV - Pharmacochimie et Biologie pour le Développement
25 Hôpital Saint-Joseph [Marseille]
26 Hôpital Claude Huriez [Lille]
27 Hôpital Saint-André
28 Hôpital Hôtel-Dieu de Clermont-Ferrand
29 CHU Saint-Antoine [AP-HP]
30 IMRB - Institut Mondor de Recherche Biomédicale
31 Service d'hépato-gastro-entérologie [APHP Henri Mondor]
32 CHU Tenon [AP-HP]
33 Hôpital Paul Brousse
34 CHU Trousseau [APHP]
35 CHIAP - Centre Hospitalier d'Aix en Provence [Aix-en-Provence]
36 Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen]
37 COMETE - Mobilités : Vieillissement, Pathologie, Santé
38 CHU Pitié-Salpêtrière [AP-HP]
39 Centre Hospitalier Le Mans (CH Le Mans)
40 Hôpital de la Milétrie
41 IMM - Institut Mutualiste de Montsouris
42 CHU Amiens-Picardie
43 Hôpital Robert Debré
44 Hôpital Foch [Suresnes]
45 Service d'hépatologie
46 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
47 UPD5 - Université Paris Descartes - Paris 5
48 Service de médecine interne et centre de référence des maladies rares [CHU Cochin]
49 Service Maladies infectieuses et tropicales [AP-HP Hôpital Cochin]
50 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
51 Service d'hépatologie médicale [CHU Cochin]
52 Immunobiologie des Cellules dendritiques
53 Service de santé publique [Mondor]
Valérie Bourcier
  • Fonction : Auteur
  • PersonId : 945946
Richard Layese
Hélène Fontaine
Victor de Ledinghen
Denis Ouzan
Fabien Zoulim
Dominique Roulot
  • Fonction : Auteur
  • PersonId : 853994
Armand Abergel
Lawrence Serfaty
Christine Silvain
Christos Christidis
David Zucman
Vincent Di Martino

Résumé

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.

Dates et versions

hal-01447065 , version 1 (26-01-2017)

Identifiants

Citer

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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