Back to Search
Start Over
The dynamic effect of direct‐acting antiviral treatments on the risk of hepatocellular carcinoma in patients with cirrhosis and chronic hepatitis C
- Source :
- Journal of Viral Hepatitis, Journal of Viral Hepatitis, 2019, 26 (12), pp.1489--1492. ⟨10.1111/jvh.13186⟩
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
Abstract
- International audience; There is still some controversy over a potentially increased short-term risk of developing hepatocellular carcinoma (HCC) after the initiation of direct-acting antiviral (DAA) therapy, even though a decreased long-term risk of HCC has been reported following a sustained virological response in patients with chronic hepatitis C virus (HCV) infection. We characterized the time-varying effect of DAAs on the risk of the occurrence of HCC in patients with cirrhosis and HCV infection. We analysed patients with cirrhosis and chronic HCV infection from the ANRS CO22 HEPATHER cohort study. We excluded patients with active HBV coinfection, liver transplantation or a past history of HCC. We used a flexible weighted effect cumulative exposure Cox model to characterize the time-varying effect of DAAs on the risk of HCC. A total of 3595 patients, mean age 59.3 years old, 65% men, were eligible for the study. Median follow-up was 36.8 months (IQR 24.6-47.1). DAAs were started during follow-up in 3292 patients. Three hundred and fifty-six HCCs were reported (275 treated, 81 untreated). Overall, a constant decrease in the risk of occurrence of HCC (vs untreated) was found from the start of treatment. Results were similar in patients without a history of decompensated cirrhosis (DC). Analysis of patients with a past history of DC showed a nonsignificant increase in the occurrence of HCC over the first 6 months, while the HR was significantly decreased at 14 months. These findings support the urgent initiation of DAAs in all patients.
- Subjects :
- Liver Cirrhosis
Male
Cirrhosis
Hepatocellular carcinoma
Biopsy
medicine.medical_treatment
Liver transplantation
medicine.disease_cause
Gastroenterology
0302 clinical medicine
Risk Factors
[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases
030212 general & internal medicine
Hepatitis C virus
Liver Neoplasms
time-varying effect
Middle Aged
[SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences
[SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences
Treatment Outcome
Infectious Diseases
[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases
Coinfection
Female
030211 gastroenterology & hepatology
Cohort study
Adult
medicine.medical_specialty
Carcinoma, Hepatocellular
[SDV.CAN]Life Sciences [q-bio]/Cancer
Antiviral Agents
Risk Assessment
Virus
03 medical and health sciences
[SDV.CAN] Life Sciences [q-bio]/Cancer
Virology
Internal medicine
medicine
Humans
Aged
Weighted cumulative exposure model
Hepatology
Proportional hazards model
business.industry
[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology
Hepatitis C, Chronic
medicine.disease
[SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology
digestive system diseases
[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie
Direct-acting antiviral agents
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
business
Biomarkers
Follow-Up Studies
Subjects
Details
- ISSN :
- 13652893 and 13520504
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Journal of Viral Hepatitis
- Accession number :
- edsair.doi.dedup.....b8e7d82e4608508a95593ac86a638d1c