Abstract
Background
In HCV-infected patients with advanced liver disease, the direct antiviral agents (DAAS)-associated clinical benefits remain debated. We compared the clinical outcome of patients with a previous history of decompensated cirrhosis following treatment or not with DAAs 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 (SVR) and its clinical benefits
Results
559 patients met the identification criteria, of which 483 received DAA 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 DAAs 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 SVR was 88%. According to adjusted multivariable analysis, SVR 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 DAAS is associated with reduced risk for mortality. Thus, DAA treatment should be considered for any patient with HCV-related decompensated cirrhosis.
Direct Antiviral Agents for the Treatment of Hcv Reinfection after Liver Transplantation
