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

doi:10.1053/J.GASTRO.2016.09.009

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

Journal Article•DOI•

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

Pierre Nahon¹, Pierre Nahon², Valérie Bourcier, Richard Layese², Etienne Audureau², Carole Cagnot, Patrick Marcellin, Dominique Guyader, Hélène Fontaine, Dominique Larrey, Victor de Ledinghen, Denis Ouzan, Fabien Zoulim³, Dominique Roulot, Albert Tran¹, Jean-Pierre Bronowicki⁴, Jean-Pierre Zarski, Vincent Leroy, Ghassan Riachi, Paul Calès, Jean-Marie Péron, Laurent Alric, Marc Bourlière, Philippe Mathurin, Sébastien Dharancy, Jean-Frédéric Blanc, Armand Abergel, Lawrence Serfaty, Ariane Mallat, Jean-Didier Grangé, Pierre Attali, Yannick Bacq, Claire Wartelle, Thong Dao, Yves Benhamou, Christophe Pilette, Christine Silvain, Christos Christidis, Dominique Capron, Brigitte Bernard-Chabert, David Zucman, Vincent Di Martino, Vincent Thibaut, Dominique Salmon⁵, Marianne Ziol, Angela Sutton², Stanislas Pol⁵, Françoise Roudot-Thoraval², Gérard Thiéfin, Sophie Hillaire - Show less +46 more•Institutions (5)

French Institute of Health and Medical Research¹, University of Paris², University of Lyon³, University of Lorraine⁴, Paris Descartes University⁵

01 Jan 2017-Gastroenterology (Elsevier)-Vol. 152, Iss: 1, pp 142-156

TL;DR: A reduction in critical events, liver-related or not, was confirmed in the CirVir cohort, a prospective study of patients with HCV infection and compensated cirrhosis included in the ANRS cohort who achieved an SVR, to reduce overall mortality and risk of death from liver- related and non-liver-related causes.

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About: This article is published in Gastroenterology.The article was published on 2017-01-01 and is currently open access. It has received 412 citations till now. The article focuses on the topics: Hepatitis C & Hazard ratio.

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Journal Article•DOI•

EASL Recommendations on Treatment of Hepatitis C

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Jean-Michel Pawlotsky, Alessio Aghemo, Geoffrey Dusheiko, Xavier Forns, Massimo Puoti, Christophe Sarrazin - Show less +2 more

01 Aug 2018-Journal of Hepatology

TL;DR: The optimal management of patients with acute and chronic HCV infections in 2018 and onwards is described, as well as developments in diagnostic procedures and improvements in therapy and prevention.

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2,491 citations

Cites background from "Eradication of Hepatitis C Virus In..."

...Patients with HCC, without cirrhosis or with compensated cirrhosis, with an indication for liver transplantation In patients with HCC, without cirrhosis or with compensated cirrhosis, who have an indication for liver transplantation, the ideal timing for antiviral therapy (before or after liver transplantation) remains debated.123,124 Lower SVR rates were reported in patients with HCC treated with regimens including sofosobuvir, sofosbuvir and ledipasvir, or ombitasvir and ritonavirboosted paritaprevir plus dasabuvir, with or without ribavirin, than in patients without HCC or in patients with HCC treated after liver transplantation (74% vs. 91% and 94%, respectively).125 Post-liver transplantation treatment of HCV was reported to be cost-effective in patients with HCC.122 In patients with HCC, without cirrhosis or with compensated cirrhosis, who have an indication for liver transplantation, pre- or post-liver transplant antiviral treatment indications are similar to those in patients who do not have HCC, and depend on the HCV genotype, prior therapy and severity of liver disease (see general recommendations)....
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...8 vol. 69 j 461–511 463 Guidelines Long-term follow-up studies have shown that an SVR corresponds to a definitive cure of HCV infection in the vast majority of cases.39 Undetectable HCV core antigen 24 weeks after the end of therapy can be used as an alternative to HCV RNA testing to define the SVR24, respectively, in patients with detectable core antigen before treatment.23,24,26,40 In patients with advanced fibrosis (METAVIR score F3) and cirrhosis (F4), an SVR reduces the rate of decompensation and will also reduce, but not abolish, the risk of HCC.8 Thus, in these patients, surveillance for HCC must be continued....
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...After 12 weeks of therapy, 95% (20/ 21; no virological failure) of them achieved an SVR.107 In another phase II trial, patients were treated with the combination of sofosbuvir and ledipasvir for 12 weeks....
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...In patients with advanced fibrosis (METAVIR score F3) and cirrhosis (F4), an SVR reduces the rate of decompensation and will also reduce, but not abolish, the risk of HCC.(8) Thus, in these patients, surveillance for HCC must be continued....
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...E-mail address: easloffice@easloffice.eu. failure and portal hypertension is reduced after an SVR. Recent data suggest that the risk of HCC and liver-related mortality is significantly reduced, but not eliminated, in patients with cirrhosis who clear HCV compared to untreated patients and non-sustained virological responders, especially in the presence of cofactors of liver morbidity, such as the metabolic syndrome, harmful alcohol consumption and/or concurrent hepatitis B virus (HBV) infection.3–9 HCV is also associated with a number of extra-hepatic manifestations and viral elimination induces reversal of most of them with reduction of all-cause mortality.10–16 These EASL Recommendations on Treatment of Hepatitis C are intended to assist physicians and other healthcare providers, as well as patients and other interested individuals, in the clinical decision-making process, by describing the current optimal management of patients with acute and chronic HCV infections....
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Journal Article•DOI•

Risk of Hepatocellular Cancer in HCV Patients Treated With Direct-Acting Antiviral Agents

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Fasiha Kanwal¹, Fasiha Kanwal², Jennifer R. Kramer¹, Jennifer R. Kramer², Steven M. Asch³, Steven M. Asch², Maneerat Chayanupatkul¹, Yumei Cao¹, Hashem B. El-Serag², Hashem B. El-Serag¹ - Show less +6 more•Institutions (3)

Baylor College of Medicine¹, Veterans Health Administration², Stanford University³

01 Oct 2017-Gastroenterology

TL;DR: In patients with SVR, the absolute risk of HCC remained high in patients with established cirrhosis, but among patients treated with DAA, SVR was associated with a considerable reduction in the risk ofHCC.

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624 citations

Journal Article•DOI•

EASL recommendations on treatment of hepatitis C: Final update of the series ☆

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Jean-Michel Pawlotsky, Francesco Negro, Alessio Aghemo, Marina Berenguer, Olav Dalgard, Geoffrey Dusheiko, Fiona Marra, Massimo Puoti, Heiner Wedemeyer - Show less +5 more

01 Nov 2020-Journal of Hepatology

TL;DR: These European Association for the Study of the Liver recommendations on treatment of hepatitis C describe the optimal management of patients with recently acquired and chronic HCV infections in 2020 and onwards.

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582 citations

Cites background from "Eradication of Hepatitis C Virus In..."

...A large-scale study from the Veterans Administration has shown that an increased risk for HCC persists up to 10 years after HCV eradication in patients with cirrhosis or a high FIB-4 score at HCV treatment baseline, justifying post-SVR surveillance in these patients.229 IFNhas been shown to improve outcomes following ablation or resection of HCC....
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...A higher SVR rate was observed in patients who received curative HCC therapy than in those who received non-curative therapy or were not treated.225 In a retrospective cohort study of 149 liver transplantation candidates with HCV infection and HCC at a single centre, patients treated with DAAs for their HCV infection had lower risk of waitlist dropout due to tumour progression or death compared to the patients who had not been treated.226 Post-liver transplantation treatment of HCV was reported to be cost-effective in patients with HCC.190 In patients with HCC, without cirrhosis or with compensated cirrhosis, with an indication for liver transplantation, pre- or post-liver transplant antiviral treatment indications are similar to those in patients who do not have HCC (see general recommendations)....
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...Long-term follow-up studies have shown that an SVR corresponds to a definitive cure of HCV infection in the vast majority of cases.5,93 In patients with advanced fibrosis (METAVIR score F3) and cirrhosis (F4), an SVR reduces the rate of decompensation and will also reduce, but not abolish, the risk of HCC.12 Thus, in these patients, surveillance for HCC must be continued....
[...]
...In patients with advanced fibrosis (METAVIR score F3) and cirrhosis (F4), an SVR reduces the rate of decompensation and will also reduce, but not abolish, the risk of HCC.(12) Thus, in these patients, surveillance for HCC must be continued....
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...Lower SVR rates have been reported with various DAA regimens in patients with HCC.224 In a systematic review with meta-analysis including 5,522 patients with HCC from 56 studies, the overall SVR rate was 88%....
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Journal Article•DOI•

Epidemiology and surveillance for hepatocellular carcinoma: New trends

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Amit G. Singal¹, Pietro Lampertico², P. Nahon³•Institutions (3)

University of Texas Southwestern Medical Center¹, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico², Paris Descartes University³

01 Feb 2020-Journal of Hepatology

TL;DR: The current state of HCC surveillance is reviewed and areas for future research are highlighted, including improved risk stratification of at-risk patients, surveillance tools with higher sensitivity and specificity for early HCC, and interventions to increase surveillance utilisation.

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539 citations

Journal Article•DOI•

Risk factors and prevention of hepatocellular carcinoma in the era of precision medicine

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Naoto Fujiwara¹, Scott L. Friedman¹, Nicolas Goossens², Yujin Hoshida¹•Institutions (2)

Icahn School of Medicine at Mount Sinai¹, Geneva College²

01 Mar 2018-Journal of Hepatology

TL;DR: Individual HCC risk prediction is expected to overcome the challenge by enabling personalised chemoprevention, targeting high-risk patients for precision HCC prevention and substantially improving the dismal prognosis of HCC.

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457 citations

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References

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Journal Article•DOI•

The Strengthening the Reporting of Observational Studies in Epidemiology [STROBE] statement: guidelines for reporting observational studies

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Erik von Elm¹, Douglas G. Altman², Matthias Egger³, Matthias Egger⁴, Stuart J. Pocock⁵, Peter C Gøtzsche⁶, Jan P. Vandenbroucke⁷ - Show less +3 more•Institutions (7)

University Hospital of Lausanne¹, University of Oxford², University of Bristol³, University of Bern⁴, University of London⁵, Cochrane Collaboration⁶, Leiden University⁷

16 Oct 2007-PLOS Medicine

TL;DR: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study, resulting in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.

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Abstract: Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the Web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.

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15,454 citations

Journal Article•DOI•

Management of hepatocellular carcinoma: An update

[...]

Jordi Bruix¹, Morris Sherman²•Institutions (2)

University of Barcelona¹, University Health Network²

01 Mar 2011-Hepatology

TL;DR: The American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of hepatocellular carcinoma (HCC) were updated in 2010 as discussed by the authors.

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6,964 citations

AASLD PRACTICE GUIDELINE Management of Hepatocellular Carcinoma: An Update

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Jordi Bruix, Morris Sherman

01 Jan 2010

TL;DR: Since the publication of the American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of hepatocellular carcinoma (HCC) in 2005, new information has emerged that requires that the guidelines be updated.

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Abstract: Since the publication of the American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of hepatocellular carcinoma (HCC) in 2005, new information has emerged that requires that the guidelines be updated. The full version of the new guidelines is available on the AASLD Web site at http://www.aasld.org/practiceguidelines/ Documents/Bookmarked%20Practice%20Guidelines/ HCCUpdate2010.pdf. Here, we briefly describe only new or changed recommendations.

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6,642 citations

"Eradication of Hepatitis C Virus In..." refers methods in this paper

...WhenHCC diagnosiswas established, treatmentwas determined using a multidisciplinary approach according to the American Association for the Study of Liver Diseases guidelines for HCC.(17,18) All patients were followed up uniformly according to these international recommendations, irrespective of SVR status....
[...]
...WhenHCC diagnosiswas established, treatmentwas determined using a multidisciplinary approach according to the American Association for the Study of Liver Diseases guidelines for HCC.17,18 All patients were followed up uniformly according to these international recommendations, irrespective of SVR status....
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...formed according to the 2005 American Association for the Study of Liver Diseases guidelines,(17) updated in 2011.(18) HCC diagnosis thus was established either by histologic examination performed by an experienced pathologist or by using probabi-...
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...During follow-up evaluation, 39 patients were transplanted, 27 for end-stage liver disease and 12 for HCC. Ninety-one patients (58.0...
[...]

Journal Article•DOI•

Management of hepatocellular carcinoma.

[...]

Jordi Bruix¹, Morris Sherman²•Institutions (2)

University of Barcelona¹, University Health Network²

01 Nov 2005-Hepatology

TL;DR: The prevention of Cirrhosis can prevent the development of HCC and progression from chronic HCV infection to advanced fibrosis or cirrhosis may be prevented in 40% of patients who are sustained responders to new antiviral strategies, such as pegylated interferon and ribavirin.

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5,557 citations

"Eradication of Hepatitis C Virus In..." refers methods in this paper

...WhenHCC diagnosiswas established, treatmentwas determined using a multidisciplinary approach according to the American Association for the Study of Liver Diseases guidelines for HCC.(17,18) All patients were followed up uniformly according to these international recommendations, irrespective of SVR status....
[...]
...WhenHCC diagnosiswas established, treatmentwas determined using a multidisciplinary approach according to the American Association for the Study of Liver Diseases guidelines for HCC.17,18 All patients were followed up uniformly according to these international recommendations, irrespective of SVR status....
[...]
...During follow-up evaluation, 39 patients were transplanted, 27 for end-stage liver disease and 12 for HCC. Ninety-one patients (58.0...
[...]

Journal Article•DOI•

Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies

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Peter C. Austin

01 Mar 2011-Pharmaceutical Statistics

TL;DR: An extensive series of Monte Carlo simulations were conducted to determine the optimal caliper width for estimating differences in means (for continuous outcomes) and risk differences (for binary outcomes).

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Abstract: In a study comparing the effects of two treatments, the propensity score is the probability of assignment to one treatment conditional on a subject's measured baseline covariates. Propensity-score matching is increasingly being used to estimate the effects of exposures using observational data. In the most common implementation of propensity-score matching, pairs of treated and untreated subjects are formed whose propensity scores differ by at most a pre-specified amount (the caliper width). There has been a little research into the optimal caliper width. We conducted an extensive series of Monte Carlo simulations to determine the optimal caliper width for estimating differences in means (for continuous outcomes) and risk differences (for binary outcomes). When estimating differences in means or risk differences, we recommend that researchers match on the logit of the propensity score using calipers of width equal to 0.2 of the standard deviation of the logit of the propensity score. When at least some of the covariates were continuous, then either this value, or one close to it, minimized the mean square error of the resultant estimated treatment effect. It also eliminated at least 98% of the bias in the crude estimator, and it resulted in confidence intervals with approximately the correct coverage rates. Furthermore, the empirical type I error rate was approximately correct. When all of the covariates were binary, then the choice of caliper width had a much smaller impact on the performance of estimation of risk differences and differences in means. Copyright © 2010 John Wiley & Sons, Ltd.

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2,538 citations

"Eradication of Hepatitis C Virus In..." refers methods in this paper

...Risk of complications and death then were tested by multivariate Cox models on the subgroup of 630 patients matched on propensity score.(24,25)...
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