Carrat F, et al. - Patients in the French ANRS CO22 Hepather cohort treated with direct-acting antivirals for chronic hepatitis C virus (HCV) infection were compared with those untreated for the incidence of death, hepatocellular carcinoma, and decompensated cirrhosis. Outcomes revealed lower risk for mortality and hepatocellular carcinoma in correlation with treatment with direct-acting antivirals. All patients with chronic hepatitis C virus (HCV) infection should be considered for treatment.

Methods

• In this prospective study, researchers enrolled adult patients with chronic HCV infection from 32 expert hepatology centers in France.
• Patients with chronic hepatitis B, those with a history of decompensated cirrhosis, hepatocellular carcinoma, or liver transplantation, and patients who were treated with interferon-ribavirin with or without first-generation protease inhibitors were all excluded.
• Incidence of all-cause mortality, hepatocellular carcinoma, and decompensated cirrhosis were the co-primary study outcomes.

Results

• From August 6, 2012, to December 31, 2015, researchers identified 10,166 eligible patients for the study; follow-up information was available for 9,895 (97%) patients who were then included in analyses.
• Median follow-up was 33.4 months (IQR 24.0–40.7), during which 7,344 patients received treatment with direct-acting antivirals; 2,551 patients who were still untreated at the final follow-up visit.
• During follow-up, death was reported for 218 patients (129 treated, 89 untreated), hepatocellular carcinoma in 258 patients (187 treated, 71 untreated), and decompensated cirrhosis in 106 patients (74 treated, 32 untreated).
• Direct-acting antiviral treatment seemed to be associated with increased risk for hepatocellular carcinoma (unadjusted hazard ratio [HR] 2.77, 95% CI 2.07–3.71) and decompensated cirrhosis (3.83, 2.29–6.42).
• They observed a decrease in all-cause mortality (adjusted HR 0.48, 95% CI 0.33–0.70) and hepatocellular carcinoma (0.66, 0.46–0.93), and no decompensated cirrhosis (1.14, 0.57–2.27) in correlation with exposure to direct-acting antivirals, after adjustment for variables (age, sex, body-mass index, geographical origin, infection route, fibrosis score, HCV treatment-naive, HCV genotype, alcohol consumption, diabetes, arterial hypertension, biological variables, and model for end-stage liver disease score in patients with cirrhosis).