Clinical outcomes after treatment with direct antiviral agents: beyond the virological response in patients with previous HCV-related decompensated cirrhosis

被引：8

作者：

Pageaux, Georges-Philippe ^{[1
]}

Nzinga, Clovis Lusivika ^{[2
]}

Ganne, Nathalie ^{[3
,4
,5
]}

Samuel, Didier ^{[6
,7
,8
]}

Dorival, Celine ^{[2
]}

Zoulim, Fabien ^{[9
]}

Cagnot, Carole ^{[10
]}

Decaens, Thomas ^{[11
,12
,13
]}

Thabut, Dominique ^{[14
]}

Asselah, Tarik ^{[15
]}

Mathurin, Philippe ^{[16
,17
]}

Habersetzer, Francois ^{[18
]}

Bronowicki, Jean-Pierre ^{[19
,20
]}

Guyader, Dominique ^{[21
,22
]}

Rosa, Isabelle ^{[23
]}

Leroy, Vincent ^{[24
]}

Chazouilleres, Olivier ^{[25
]}

de Ledinghen, Victor ^{[26
]}

Bourliere, Marc ^{[27
]}

Causse, Xavier ^{[28
]}

Cales, Paul ^{[29
,30
]}

Metivier, Sophie ^{[31
]}

Loustaud-Ratti, Veronique ^{[32
]}

Riachi, Ghassan ^{[33
]}

Alric, Laurent ^{[34
]}

Gelu-Simeon, Moana ^{[35
,36
]}

Minello, Anne ^{[37
]}

Gournay, Jerome ^{[38
]}

Geist, Claire ^{[39
]}

Tran, Albert ^{[40
]}

Abergel, Armand ^{[41
,42
]}

Portal, Isabelle ^{[43
]}

d'Alteroche, Louis ^{[44
]}

Raffi, Francois ^{[45
]}

Fontaine, Helene ^{[46
]}

Carrat, Fabrice ^{[2
,47
]}

Pol, Stanislas ^{[47
,48
,49
,50
]}

机构：

[1] Univ Montpellier, Dept Hepatol & Gastroenterol, Ctr Hosp Univ St Eloi, F-34295 Montpellier, France

[2] Sorbonne Univ, Inst Natl Sante & Rech Med, Inst Pierre Louis Epidemiol & Sante Publ, Paris, France

[3] Hop Univ Paris Seine St Denis, AP HP, Dept Hepatol, Site Avicenne, Bobigny, France

[4] Univ Paris 13, Sorbonne Paris Cite, Paris, France

[5] INSERM UMR 1162, Paris, France

[6] Hop Paul Brousse, AP HP, Ctr Hepatobiliaire, F-94800 Villejuif, France

[7] Univ Paris Saclay, INSERM, Physiopathogenese & Traitement Malad Foie, F-94800 Villejuif, France

[8] Univ Paris Saclay, Hepatinov, Unite 1193, INSERM, F-94800 Villejuif, France

[9] Univ Lyon, Dept Hepatol, Hosp Civils Lyon, INSERM U1052, Lyon, France

[10] ANRS France REch Nord & Sud Sida Vih Hepatites, Unit Basic & Clin Res Viral Hepatitis, Paris, France

[11] Univ Grenoble Alpes, F-38000 Grenoble, France

[12] Inst Adv Biosci, Res Ctr Inserm U1209, CNRS UMR5309, F-38700 La Tronche, France

[13] CHU Grenoble Alpes, Serv Hapatogastroenterol, Pole Digidune, F-38700 La Tronche, France

[14] Sorbonne Univ, Grp Hosp Pitie Salpetriere, AP HP, INSERM UMR S938,Dept Hepatol & Gastroenterol, Paris, France

[15] Univ Paris Diderot, Hosp Beaujon, Ctr Rech Inflammat, CRI,INSERM UMR 1149,Hepatol, Clichy, France

[16] Univ Lille 2, Serv Malad Appareil Digestif, Lille, France

[17] Inserm U795, Lille, France

[18] Inserm 1110, CIC, Strasbourg, France

[19] Univ Lorraine, Univ Hosp Nancy Brabois, Inserm U1254, Vandoeuvre Les Nancy, France

[20] Univ Lorraine, Univ Hosp Nancy Brabois, Dept Hepatogastroenterol, Vandoeuvre Les Nancy, France

[21] CHU Rennes, Serv Hepatol, F-35033 Rennes, France

[22] Univ Rennes1, INRA, INSERM, Inst NUMECAN Nutr Metabol & Canc,UMR A 1341,UMR S, F-35033 Rennes, France

[23] Ctr Hosp Intercommunal, Dept Hepatol & Gastroenterol, Creteil, France

[24] Univ Paris Est, Hop Henri Mondor, AP HP, Dept Hepatol & Gastroenterol,INSERM U955, Creteil, France

[25] Sorbonne Univ, Hop St Antoine, AP HP, Dept Hepatol, Paris, France

[26] Univ Bordeaux Segalen, Hepatol Unit, INSERM U1053, Hop Haut Leveque, Bordeaux, France

[27] Hop St Joseph, Dept Hepatol & Gastroenterol, Marseille, France

[28] CHR Orleans, Dept Hepatol & Gastroenterol, Orleans, France

[29] Univ Hosp, Hepatol Dept, Angers, France

[30] Angers Univ, HIFIH Lab, Angers, France

[31] CHU Rangueil, Hepa Tol Unit, F-31059 Toulouse, France

[32] Univ Limoges, Dept Hepatol & Gastroenterol, U1248 INSERM, CHU Limoges, F-87000 Limoges, France

[33] CHU Charles Nicolle, Dept Hepatol & Gastroenterol, Rouen, France

[34] IRD Toulouse 3 Univ, Dept Internal Med & Digest Dis, UMR 152 Pharma Dev, CHU Purpan, Toulouse, France

[35] Univ Antilles, Fac Med, CHU Guadeloupe, Serv Hepatogastroenterol, F-97110 Pointe A Pitre, France

[36] INSERM, UMR S1085 IRSET, F-35043 Rennes, France

[37] Univ Hosp Dijon, Dept Hepatol & Gastroenterol, INSERM UMR 1231, Dijon, France

[38] Univ Hosp Nantes, Inst Malad Appareil Digestif, Gastroenterol & Hepatol Dept, Nantes, France

[39] Ctr Hosp Reg, Dept Hepatol & Gastroenterol, Metz, France

[40] Ctr Hosp Univ Nice, Digest Ctr, INSERM U1065 8, Nice, France

[41] Estaing Univ Hosp, Dept Digest & Hepatobiliary Dis, Clermont Ferrand, France

[42] UMR 6602 CNRS Sigma Univ Clermont Auvergne, Clermont Ferrand, France

[43] Aix Marseille Univ, Hop La Timone, AP HM, Serv Hepatogastroenterol, Marseille, France

[44] CHU Trousseau, Unit Hepatol, Hepatogastroenterol, F-37044 Tours, France

[45] Nantes Univ Hosp, Hotel Dieu Hosp, Dept Infect Dis, INSERM CIC 1413, Nantes, France

[46] Hop Cochin, Assistance Publ Hop Paris, Unite Hepatol, Paris, France

[47] Hop St Antoine, Assistance Publ Hop Paris, Unite Sante Publ, Paris, France

[48] Univ Paris 05, Paris, France

[49] Inst Pasteur, INSERM U1223, Paris, France

[50] Inst Pasteur, USM20, Paris, France

来源：

BMC INFECTIOUS DISEASES | 2022年 / 22卷 / 01期

关键词：

Hepatitis C virus; Decompensated cirrhosis; Direst-acting antiviral agents; Survival; Hepatocellular carcinoma; Sustained virological response; CHRONIC HEPATITIS-C; ALL-CAUSE MORTALITY; VIRAL ERADICATION; VIRUS-INFECTION; LIVER; SOFOSBUVIR;

D O I：

10.1186/s12879-022-07076-0

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Background In HCV-infected patients with advanced liver disease, the direct antiviral agents-associated clinical benefits remain debated. We compared the clinical outcome of patients with a previous history of decompensated cirrhosis following treatment or not with direct antiviral agents from the French ANRS CO22 HEPATHER cohort. Methods We identified HCV patients who had experienced an episode of decompensated cirrhosis. Study outcomes were all-cause mortality, liver-related or non-liver-related deaths, hepatocellular carcinoma, liver transplantation. Secondary study outcomes were sustained virological response and its clinical benefits. Results 559 patients met the identification criteria, of which 483 received direct antiviral agents and 76 remained untreated after inclusion in the cohort. The median follow-up time was 39.7 (IQR: 22.7-51) months. After adjustment for multivariate analysis, exposure to direct antiviral agents was associated with a decrease in all-cause mortality (HR 0.45, 95% CI 0.24-0.84, p = 0.01) and non-liver-related death (HR 0.26, 95% CI 0.08-0.82, p = 0.02), and was not associated with liver-related death, decrease in hepatocellular carcinoma and need for liver transplantation. The sustained virological response was 88%. According to adjusted multivariable analysis, sustained virological response achievement was associated with a decrease in all-cause mortality (HR 0.29, 95% CI 0.15-0.54, p < 0.0001), liver-related mortality (HR 0.40, 95% CI 0.17-0.96, p = 0.04), non-liver-related mortality (HR 0.17, 95% CI 0.06-0.49, p = 0.001), liver transplantation (HR 0.17, 95% CI 0.05-0.54, p = 0.003), and hepatocellular carcinoma (HR 0.52, 95% CI 0.29-0.93, p = 0.03). Conclusion Treatment with direct antiviral agents is associated with reduced risk for mortality. The sustained virological response was 88%. Thus, direct antiviral agents treatment should be considered for any patient with HCV-related decompensated cirrhosis. Trial registration: ClinicalTrials.gov registry number: NCT01953458.

引用

页数：12

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