학술논문
Clinical outcomes after treatment with direct antiviral agents: beyond the virological response in patients with previous HCV-related decompensated cirrhosis
Document Type
article
Author
Georges-Philippe Pageaux; Clovis Lusivika Nzinga; Nathalie Ganne; Didier Samuel; Céline Dorival; Fabien Zoulim; Carole Cagnot; Thomas Decaens; Dominique Thabut; Tarik Asselah; Philippe Mathurin; François Habersetzer; Jean-Pierre Bronowicki; Dominique Guyader; Isabelle Rosa; Vincent Leroy; Olivier Chazouilleres; Victor de Ledinghen; Marc Bourliere; Xavier Causse; Paul Cales; Sophie Metivier; Véronique Loustaud-Ratti; Ghassan Riachi; Laurent Alric; Moana Gelu-Simeon; Anne Minello; Jérôme Gournay; Claire Geist; Albert Tran; Armand Abergel; Isabelle Portal; Louis d’Alteroche; François Raffi; Hélène Fontaine; Fabrice Carrat; Stanislas Pol; For the French ANRS CO22 Hepather Cohort
Source
BMC Infectious Diseases, Vol 22, Iss 1, Pp 1-12 (2022)
Subject
Language
English
ISSN
1471-2334
Abstract
Abstract 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