SNFGE SNFGE
 
Thématique :
- Foie
- Hépatites virales
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Gut
  2015/03  
 
  2015 Mar;64(3):495-503  
  doi: 10.1136/gutjnl-2014-308163  
 
  Association between antiviral treatment and extrahepatic outcomes in patients with hepatitis C virus infection  
 
  Hsu YC, Ho HJ, Huang YT, Wang HH, Wu MS, Lin JT, Wu CY  
  http://www.ncbi.nlm.nih.gov/pubmed/25398770  
 
 

Objective
To elucidate the association between antiviral therapy and extrahepatic outcomes in  individuals infected with HCV.

Methods
This nationwide cohort study screened 293 480 Taiwanese residents with HCV infection and excluded those with substantial comorbidity. A total of 12 384 eligible patients who had received pegylated interferon plus ribavirin between 1 October 2003 and 31 December 2010 were enrolled in the treated cohort; they were matched 1 : 2 with 24 768 untreated controls in the propensity score and post-diagnosis treatment-free period. The incidences of end-stage renal disease (ESRD), acute coronary syndrome (ACS), ischaemic stroke and catastrophic autoimmune diseases were calculated after adjustment for competing mortality.

Results
The treated and untreated cohorts were followed up for a mean (±SD) duration of 3.3 (±2.5) and 3.2 (±2.4) years, respectively, until 31 December 2011. The calculated 8-year cumulative incidences of ESRD, ACS, ischaemic stroke and autoimmune catastrophes between treated and untreated patients were 0.15% vs 1.32% ( p<0.001), 2.21% vs 2.96% (p=0.027), 1.31% vs 1.76% (p=0.001) and 0.57% vs 0.49% (p=0.816), respectively. Multivariate-adjusted Cox regression revealed that antiviral treatment was associated with lower risks of ESRD (HR 0.15; 95% CI 0.07 to 0.31; p<0.001), ACS (HR 0.77; 95% CI 0.62 to 0.97; p=0.026) and ischaemic stroke (HR 0.62; 95% CI 0.46 to 0.83; p=0.001), but unrelated to autoimmune catastrophes. These favourable associations were invalid in incompletely treated patients with duration <16 weeks.

Conclusions
Antiviral treatment for HCV is associated with improved renal and circulatory outcomes, but unrelated to catastrophic autoimmune diseases.

 
Question posée
 
Le traitement anti-VHC (IFN peg + RBV) diminue-t-il l’incidence de l’insuffisance rénale chronique terminale, de l’insuffisance coronarienne aiguë, de l’accident vasculaire cérébral et des atteintes auto-immunes dans une large population de Taïwan ?
 
Question posée
 
Le traitement anti-VHC pendant au moins 16 semaines améliore bien les risques rénaux et vasculaires mais pas celui des atteintes auto-immunes avec une amélioration de la survie.
 
Commentaires

Il existe bien un bénéfice extra-hépatique à traiter les patients ayant une hépatite chronique virale C quelle que soit la réponse au traitement et cela est aussi bien confirmé par la cohorte CIRVIR qui n’apporte cependant pas de réponse quant à l’atteinte auto-immune. On peut penser que les anti-viraux directs entraîneront le même bénéfice et ne sera pas limité à la population de Taïwan.

 
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