SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Jean-Marie PERON
Coup de coeur :
 
 
Gastroenterology
  2016/04  
 
  2016 Mar 31. pii: S0016-5085(16)30049-X  
  doi: 10.1053/j.gastro.2016.03.036  
 
  Effects of Viral Eradication in Patients with HCV and Cirrhosis Differ With Stage of Portal Hypertension.  
 
  Di Marco V, Calvaruso V, Ferraro D, Bavetta MG, Cabibbo G, Conte E, Cammà C, Grimaudo S, Pipitone RM, Simone F, Peralta S, Arini A, Craxì A  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Di+Marco+V1%2C+Calvaruso+V2%2C+Ferraro+D3%2C+Bavetta+MG2%2C+Cabibbo+G2%2C+Conte+E2%2C+Camm%C3%A0+C2%2C+Grimaudo+S2%2C+Pipitone+RM2%2C+Simone+F2%2C+Peralta+S2%2C+Arini+A2%2C+Crax%C3%AC+A2  
 
 

BACKGROUND & AIMS:

Clearance of hepatitis C virus (HCV) via antiviral treatment changes the course of liver disease. We evaluated the benefit of sustained virologic response (SVR) in patients with HCV and cirrhosis without (stage 1) and with (stage 2) esophageal varices (EV).

METHODS:

We performed a prospective cohort study of 444 patients with HCV and compensated cirrhosis (218 with stage 1 and 226 with stage 2 disease) treated with peg-interferon and ribavirin from June 2001 through December 2009 at the University of Palermo, Italy and followed for a median of 7.6 years (range, 1-12.6 years). We used Cox regression analysis to identify variables associated with appearance or progression of EVs, development of hepatocellular carcinoma (HCC), liver decompensation, and overall survival.

RESULTS:

In the intention-to-treat analysis, 67 patients with stage 1 disease (30.7%) and 41 patients with stage 2 disease (18.1%) achieved an SVR (P=.003). Patients with stage 1 disease and an SVR were less likely to develop EVs than stage 1 patients without an SVR (hazard ratio [HR], 0.23; 95% confidence interval [CI], 0.11-0.48; P<.001). However, SVR did not affect whether patients with stage 2 disease developed further EVs (HR, 1.58; 95% CI, 0.33-1.03; P=.07, by log-rank test). An SVR was associated with lower risk for HCC (HR, 0.25; 95% CI, 0.12-0.55; P<.001). Patients with stage 2 disease, regardless of SVR, were at greater risk than patients with stage 1 disease for liver decompensation (HR, 2.82; 95% CI, 1.73-4.59; P<.001) or death (HR, 1.77; 95% CI, 1.12-2.80; P=.015). A lower proportion of patients with stage 1 disease and an SVR died from HCC (2.9%), compared to those without an SVR (11.9%) (P=.03) or developed liver decompensation (none vs 7.1% without an SVR, P=.009). A lower proportion of patients with stage 2 disease and an SVR died from causes secondary to HCC (2.0%) compared to those without an SVR (18.4%) (P=0.003). Death from causes secondary to liver decompensation did not differ significantly between patients with stage 2 disease with or without an SVR (12.1% vs 25.4%; P=.15).

CONCLUSIONS:

In a prospective study of 444 patients with HCV and compensated cirrhosis, HCV eradication reduced risk for liver decompensation, HCC, and death, regardless of whether the patients had EVs.

 
Question posée
 
La diminution du risque de complication de la cirrhose liée à l’éradication du VHC existe-t-elle également en cas de cirrhose avec hypertension portale établie ?
 
Question posée
 
Oui le bénéfice de l’éradication virale se maintient même chez les patients avec varices oesophagiennes : diminution du risque de décompensation, de CHC et de mortalité.
 
Commentaires

Confirmation du bénéfice de l’éradication virale chez les patients avec cirrhose et HTP.

 
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