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Artigo Produção Nacional Revisado por pares
BIBTEX RIS

Disease Progression in Patients With Hepatitis C Virus Infection Treated With Direct-Acting Antiviral Agents

2020; Elsevier BV; Volume: 18; Issue: 11 Linguagem: Inglês

10.1016/j.cgh.2020.02.044

ISSN

1542-7714

Autores

Manuel Mendizábal, Federico Piñero, Ezequiel Ridruejo, Fernando Herz Wolff, Margarita Anders, Virginia Reggiardo, Beatriz Ameigeiras, Ana Palazzo, Cristina Alonso, María Isabel Schinoni, María Grazia Videla Zuain, Federico Tanno, Sebastián Figueroa, Luisa Santos, Mirta Peralta, Alejandro Soza, Cecilia Vistarini, Raúl Adrover, Nora Fernández, Daniela Perez, Nelia Hernández, Claudio Estepo, Andrés Bruno, Valeria Descalzi, Marcela Sixto, Silvia Borzi, Daniel Cocozzella, Alina Zerega, Alexandre de Araújo, Adriana Varón, Fernando Rubinstein, Hugo Cheinquer, Marcelo Silva,

Tópico(s)

Liver Disease and Transplantation

Resumo

Little is known about how a sustained virologic response (SVR) to treatment of hepatitis C virus infection with direct-acting antivirals (DAAs) affects patient mortality and development of new liver-related events. We aimed to evaluate the incidence of disease progression in patients treated with DAAs.We performed a prospective multicenter cohort study of 1760 patients who received DAA treatment at 23 hospitals in Latin America, from May 1, 2016, through November 21, 2019. We excluded patients with a history of liver decompensation, hepatocellular carcinoma (HCC), or solid-organ transplantation. Disease progression after initiation of DAA therapy included any of the following new events: liver decompensation, HCC, liver transplantation, or death. Evaluation of variables associated with the primary outcome was conducted using a time-dependent Cox proportional hazards models.During a median follow-up period of 26.2 months (interquartile range, 15.3-37.5 mo), the overall cumulative incidence of disease progression was 4.1% (95% CI, 3.2%-5.1%), and after SVR assessment was 3.6% (95% CI, 2.7%-4.7%). Baseline variables associated with disease progression were advanced liver fibrosis (hazard ratio [HR], 3.4; 95% CI, 1.2-9.6), clinically significant portal hypertension (HR, 2.1; 95% CI, 1.2-3.8), and level of albumin less than 3.5 mg/dL (HR, 4.1; 95% CI, 2.3-7.6), adjusted for SVR achievement as a time covariable. Attaining an SVR reduced the risk of liver decompensation (HR, 0.3; 95% CI, 0.1-0.8; P = .016) and de novo HCC (HR, 0.2; 95% CI, 0.1%-0.8%; P = .02) in the overall cohort.Treatment of hepatitis C virus infection with DAAs significantly reduces the risk of new liver-related complications and should be offered to all patients, regardless of disease stage. Clinicaltrials.gov: NCT03775798.

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