HCV eradication reduces complications in patients with cirrhosis
Among patients with hepatitis C virus infection and compensated cirrhosis, achieving sustained virologic response was associated with reduced overall mortality and mortality risk related to liver- and non-liver-related complications, according to an ancillary analysis of the prospectively studied CirVir cohort.
“The aim of the present report was to evaluate prospectively the impact of SVR in a large population of cirrhotic individuals by accurately detailing clinical benefits of viral clearance over the entire spectrum of complications usually observed in these patients,” investigators wrote. “Analyses particularly took into account the influence of comorbidities in patients treated by interferon-based regimens and also focused on the risk factors for complications occurring after SVR, including in the first patients treated by second-generation [direct-acting antivirals].”
Researchers identified data on 1,323 patients with HCV and cirrhosis (all Child-Pugh class A and with no previous liver complications) who were enrolled in the CirVir cohort from 35 clinical centers in France between 2006 and 2012. Physicians evaluated patients every 6 months after HCV treatment began, with ultrasound and endoscopic surveillance performed regularly.
The investigators used Cox proportional hazards regression models to evaluate the effect of SVR on the incidence of hepatocellular carcinoma, liver failure, bacterial infections, vascular events, extrahepatic cancers, overall mortality, and liver and non-liver-related death.
Overall, 50.5% of patients achieved SVR after a median follow-up period of 58.2 months, and these patients showed a lower incidence of liver- and non-liver-related complications.
SVR was associated with a lower risk for HCC (HR = 0.29; 95% CI, 0.19-0.43; P < .001), hepatic decompensation (HR = 0.26; 95% CI, 0.17-0.39; P < .001), cardiovascular events (HR = 0.42; 95% CI, 0.25-0.69; P = .001) and bacterial infection (HR = 0.44; 95% CI, 0.29-0.68; P < .001).
Metabolic features were associated with an increased risk for HCC among patients who achieved SVR, but not in patients with viremia.
SVR was also associated with reduced overall mortality (HR = 0.27; 95% CI, 0.18-0.42; P < .001) and death from liver- and non-liver related complications.
Analysis of a propensity score matched population showed similar results.
“An overall decrease in critical events, whether liver-related or owing to extrahepatic causes, was observed in patients with HCV compensated cirrhosis achieving virologic clearance,” the researchers concluded. “If confirmed by the longer follow-up evaluation of increasing numbers of DAA-treated patients, this population will define a new clinical entity with a completely different outcome and increased survival.” – by Adam Leitenberger
Disclosures: Nahon reports he has received honoraria from AbbVie, Bayer, Bristol-Myers Squibb and Gilead, and consults for AbbVie and Bristol-Myers Squibb. Please see the study for a full list of all other researchers’ relevant financial disclosures.