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Roelens M, Bertisch B, Moradpour D, Cerny A, Semmo N, Schmid P, Müllhaupt B, Clerc O, Semela D, Junker C, Negro F, Keiser O. All-Cause Mortality and Causes of Death in the Swiss Hepatitis C Cohort Study (SCCS). Open Forum Infect Dis 2020; 7:ofaa308. [PMID: 32855989 PMCID: PMC7443104 DOI: 10.1093/ofid/ofaa308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022] Open
Abstract
Background With direct-acting antiviral agents (DAAs), mortality rates and causes of death among persons with hepatitis C virus (HCV) infection may change over time. However, the emergence of such trends may be delayed by the slow progression of chronic hepatitis C. To date, detailed analyses of cause-specific mortality among HCV-infected persons over time remain limited. Methods We evaluated changes in causes of death among Swiss Hepatitis C Cohort Study (SCCS) participants from 2008 to 2016. We analyzed risk factors for all-cause and cause-specific mortality, accounting for changes in treatment, fibrosis stage, and use of injectable drugs over time. Mortality ascertainment was completed by linking lost-to-follow-up participants to the Swiss Federal Statistical Office death registry. Results We included 4700 SCCS participants, of whom 478 died between 2008 and 2016. The proportion of unknown causes of death decreased substantially after linkage, from 42% to 10%. Leading causes of death were liver failure (crude death rate 4.4/1000 person-years), liver cancer (3.4/1000 person-years), and nonliver cancer (2.8/1000 person-years), with an increasing proportion of cancer-related deaths over time. Cause-specific analysis showed that persons with sustained virologic response were less at risk for liver-related mortality than those never treated or treated unsuccessfully. Conclusions Although the expected decrease in mortality is not yet observable, causes of death among HCV-infected persons have evolved over time. With the wider use of DAAs, liver-related mortality is expected to decline in the future. Continued monitoring of cause-specific mortality will remain important to assess the long-term effect of DAAs and design effective interventions.
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Affiliation(s)
- Maroussia Roelens
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Barbara Bertisch
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Darius Moradpour
- Division of Gastroenterology and Hepatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Nasser Semmo
- Department for BioMedical Research, Hepatology, University of Bern, Bern, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Beat Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital, Zürich, Switzerland
| | - Olivier Clerc
- Department of Internal Medicine and Infectious Diseases, Pourtalès Hospital, Neuchâtel, Switzerland
| | - David Semela
- Division of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christoph Junker
- Swiss Federal Statistical Office, Section Population Health, Neuchâtel, Switzerland
| | - Francesco Negro
- Division of Gastroenterology and Hepatology, University Hospitals Geneva, Geneva, Switzerland.,Division of Clinical Pathology, University Hospitals Geneva, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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The benefit of statins in chronic hepatitis C patients: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2017; 29:759-766. [PMID: 28240613 DOI: 10.1097/meg.0000000000000867] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Besides regulating lipid metabolism, statins have garnered considerable interest because of their antiviral and antineoplastic properties. The potential benefit of statins using in chronic hepatitis C (CHC) patients is not well described. This meta-analysis was carried out to quantitatively assess the efficacy of statins in improving the therapeutic effect and prognosis of patients with CHC. PATIENTS AND METHODS We searched electronic databases for relevant studies comparing the course of benefit in CHC patients with statins versus without statins. Risk estimates were pooled to assess the association of statins use with sustained virological response and the prognosis of CHC patients. RESULTS Twenty-three studies fulfilled the inclusion criteria. Meta-analysis of 16 homogeneous studies showed that the sustained virological response rate increased by 31% [relative risk (RR)=1.31; 95% confidence interval (CI): 1.23-1.39] in 12 791 CHC patients with statins as an adjuvant under the general antiviral therapy compared with those without this adjuvant therapy. Moreover, meta-analysis of seven studies suggested that statins was beneficial on several specific poor outcomes of CHC patients (RR=0.49; 95% CI: 0.42-0.56). CHC patients with statin use were found to be inversely associated with a 55% reduced risk of hepatocellular carcinoma (RR=0.45; 95% CI: 0.36-0.57) and 53% reduced risk of cirrhosis (RR=0.47; 95% CI: 0.33-0.67) as well as 44% reduced risk of mortality (RR=0.56; 95% CI: 0.46-0.69). However, significant heterogeneity and publication bias were present in some of our analyses. CONCLUSION Beneficial effects of statins use were found in the therapy and the prognosis of CHC patients. Further prospective studies are still needed to confirm these benefits.
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Li ZQ, Hu CL, Yu P, Gu XY, Zhang JJ, Li H, Zhang HY, Lv J, Liu YM, Zeng QL, Yan JY, Yu ZJ, Zhang Y. The development of hepatocarcinoma after long-term antivirus treatment of Chinese patients with chronic hepatitis B virus infection: Incidence, long-term outcomes and predictive factors. Clin Res Hepatol Gastroenterol 2017; 41:311-318. [PMID: 28237828 DOI: 10.1016/j.clinre.2016.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with chronic hepatitis B virus (HBV) infection are at high risk for progressing to decompensated cirrhosis and hepatocellular carcinoma (HCC). Although long-term treatment with nucleos(t)ide analogues (NAs) benefits patients with chronic hepatitis B (CHB), many develop HCC. Therefore, the clinical outcomes of patients CHB who undergo long-term treatment with NAs remain to be identified. The aim of this study therefore was to evaluate the risk and predictors of patients with CHB who develop hepatitis B-induced HCC. METHODS We investigated 1200 patients with CHB who were treated with NAs for at least four years and evaluated the association of the variables ALT, HBsAg, HBV DNA, age and platelet count with the occurrence of HCC. We used multivariable analysis to identify independent risk factors for the development of HCC. RESULTS HCC developed in 153 NA-treated patients. Serum HBV DNA levels of 18.17% (218/1200) patients were>2000IU/mL. The median level of liver stiffness measurement (LSM) of all patients was 8.3±6.7kPa vs. 19.8±10.1kPa in patients with HCC. Advanced age, lower platelet counts, positive HBV DNA load, lower ALB concentration and relatively advanced liver disease were associated with an increased risk of developing HCC. Further, TGF-β and IFN-γ levels were higher and lower in patients with HCC or CHB, respectively. CONCLUSIONS Hepato-carcinogenesis occurred more frequently in patients with a positive HBV DNA load and relatively advanced liver disease. Therefore, it is important to administer antiviral therapy to patients with CHB before they develop HBV-related cirrhosis.
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Affiliation(s)
- Zhi-Qin Li
- Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China; Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
| | - Chun-Ling Hu
- Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
| | - Ping Yu
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
| | - Xin-Yu Gu
- Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
| | - Jia-Jia Zhang
- Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
| | - Hua Li
- Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
| | - Hong-Yu Zhang
- Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
| | - Jun Lv
- Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
| | - Yan-Min Liu
- Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
| | - Qing-Lei Zeng
- Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
| | - Jing-Ya Yan
- Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China.
| | - Zu-Jiang Yu
- Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
| | - Yi Zhang
- Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China; Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China; Department of Oncology, the First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China; School of Life Sciences, Zhengzhou University, 450052 Zhengzhou, Henan, China; Key Laboratory of Clinical-Medicine, the First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China
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Combination of sofosbuvir, pegylated-interferon and ribavirin for treatment of hepatitis C virus genotype 1 infection: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2017; 25:11. [PMID: 28427463 PMCID: PMC5397824 DOI: 10.1186/s40199-017-0177-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
Background Hepatitis C virus (HCV) infection is an important cause of chronic liver disease which has been affected 3% of world’s population. Some studies have shown that adding Sofosbuvir (SOF), an HCV polymerase inhibitor to the conventional therapy of Pegylated-interferon (PegIFN) plus Ribavirin (RBV) can increase the rate of sustained virologic response (SVR) among HCV-infected patients. This study was conducted to determine the effect of combination therapy with PegIFN and RBV plus SOF for chronic hepatitis C genotype 1 infection using systematic review with meta-analysis. Methods In this study, electronic databases including PubMed, Scopus, Science Direct, and Web of Science were comprehensively searched using appropriate strategies containing all related keywords of “hepatitis C”, “PegIFN”, “RBV” and “SOF”. Studies assessed the efficacy of combination therapy with PegIFN and RBV plus SOF for chronic hepatitis C genotype 1 infection were included in the meta-analysis. Results After screening of 757 records, we included five articles with total sample size of 411 to the meta-analysis. Based on the fixed-effect model (χ2 = 5.29, P = 0.26 and I2 = 24.4%), pooled SVR rate for treatment regimen of PegIFN and RBV plus SOF was calculated as 88.54% (95% CI = 85.77%–91.32%). Conclusions Combination therapy with PegIFN and RBV plus SOF results in high treatment response in patients with HCV genotype 1 infection. Electronic supplementary material The online version of this article (doi:10.1186/s40199-017-0177-x) contains supplementary material, which is available to authorized users.
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Bang CS, Song IH. Impact of antiviral therapy on hepatocellular carcinoma and mortality in patients with chronic hepatitis C: systematic review and meta-analysis. BMC Gastroenterol 2017; 17:46. [PMID: 28376711 PMCID: PMC5379714 DOI: 10.1186/s12876-017-0606-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/28/2017] [Indexed: 12/17/2022] Open
Abstract
Background The long-term clinical outcomes of antiviral therapy for patients with chronic hepatitis C are uncertain in terms of hepatitis C virus (HCV)-related morbidity and mortality according to the response to antiviral therapy. This study aimed to assess the impact of antiviral treatment on the development of HCC and mortality in patients with chronic HCV infection. Methods A systematic review was conducted for studies that evaluated the antiviral efficacy for patients with chronic hepatitis C or assessed the development of HCC or mortality between SVR (sustained virologic response) and non-SVR patients. The methodological quality of the enrolled publications was evaluated using Risk of Bias table or Newcastle-Ottawa scale. Random-effect model meta-analyses and meta-regression were performed. Publication bias was assessed. Results In total, 59 studies (4 RCTs, 15 prospective and 40 retrospective cohort studies) were included. Antiviral treatment was associated with reduced development of HCC (vs. no treatment; OR 0.392, 95% CI 0.275–0.557), and this effect was intensified when SVR was achieved (vs. no SVR, OR: 0.203, 95% CI 0.164–0.251). Antiviral treatment was associated with lower all-cause mortality (vs. no treatment; OR 0.380, 95% CI 0.295–0.489) and liver-specific mortality (OR 0.363, 95% CI 0.260–0.508). This rate was also intensified when SVR was achieved [all-cause mortality (vs. no SVR, OR 0.255, 95% CI 0.199–0.326), liver-specific mortality (OR 0.126, 95% CI 0.094–0.169)]. Sensitivity analyses revealed robust results, and a small study effect was minimal. Conclusions In patients with chronic hepatitis C, antiviral therapy can reduce the development of HCC and mortality, especially when SVR is achieved. Electronic supplementary material The online version of this article (doi:10.1186/s12876-017-0606-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Il Han Song
- Division of Hepatology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea, Republic of Korea.
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Lu M, Li J, Rupp LB, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Zhou Y, Boscarino JA, Schmidt MA, Lamerato LE, Trinacty C, Trudeau S, Gordon SC. Hepatitis C treatment failure is associated with increased risk of hepatocellular carcinoma. J Viral Hepat 2016; 23:718-29. [PMID: 27028626 PMCID: PMC5724043 DOI: 10.1111/jvh.12538] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/18/2016] [Indexed: 12/11/2022]
Abstract
Sustained virological response (SVR) to antiviral therapy for hepatitis C (HCV) reduces risk of hepatocellular carcinoma (HCC), but there is little information regarding how treatment failure (TF) compares to lack of treatment. We evaluated the impact of treatment status on risk of HCC using data from the Chronic Hepatitis Cohort Study (CHeCS-an observational study based in four large US health systems, with up to 7 years of follow-up on patients). Multivariable analyses were used to adjust for bias in treatment selection, as well as other covariates, followed by sensitivity analyses. Among 10 091 HCV patients, 3681 (36%) received treatment, 2099 (57%) experienced treatment failure (TF), and 1582 (43%) of these achieved sustained virological response (SVR). TF patients demonstrated almost twice the risk of HCC than untreated patients [adjusted hazard ratio (aHR) = 1.95, 95% confidence interval (CI) 1.50-2.53]; this risk persisted across all stages of fibrosis. Several sensitivity analyses validated these results. Although African Americans were at increased risk of treatment failure, they were at lower risk for HCC and all-cause mortality compared to White patients. SVR patients had lower risk of HCC than TF patients (aHR = 0.48, CI 0.31-0.73), whereas treatment - regardless of outcome - reduced all-cause mortality (aHR = 0.45, CI 0.34-0.60 for SVR patients; aHR = 0.78, CI 0.65-0.93 for TF patients).
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Affiliation(s)
- Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Jia Li
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Loralee B. Rupp
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Scott D. Holmberg
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anne C. Moorman
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip R. Spradling
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eyasu H. Teshale
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yueren Zhou
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | | | - Mark A. Schmidt
- Center for Health Research, Kaiser Permanente–Northwest, Portland, OR, Portland
| | - Lois E. Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Connie Trinacty
- Center for Health Research, Kaiser Permanente–Hawai’i, Waipahu, HI, USA
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Stuart C. Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, MI, USA
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Hesamizadeh K, Sharafi H, Rezaee-Zavareh MS, Behnava B, Alavian SM. Next Steps Toward Eradication of Hepatitis C in the Era of Direct Acting Antivirals. HEPATITIS MONTHLY 2016; 16:e37089. [PMID: 27275164 PMCID: PMC4893415 DOI: 10.5812/hepatmon.37089] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/21/2016] [Indexed: 12/11/2022]
Abstract
CONTEXT After the introduction of safe and highly effective hepatitis C virus (HCV) treatments, eradication of HCV in the next 20 years is the ultimate goal. Since 2011, the advent of first generation direct acting antivirals (DAAs) were started and followed by the introduction of a new wave of DAAs in 2013 which exhibit outstanding efficacy. It is obvious that the eradication of hepatitis C is not restricted to development of DAAs. EVIDENCE ACQUISITION An electronic search of available literature published was conducted in all peer-reviewed journal indexed in PubMed, Scopus and Google scholar. The literature search was done among articles related treatment of hepatitis C with DAAs in different patient groups with mass screening of the patients and cost benefit of new treatments as main key words. RESULTS There are major steps that should be taken to eradicate HCV, including (1) the development of screening strategies, particularly for groups such as intravenous drug users and recipients of blood or blood products before the introduction of HCV screening in donors; (2) the development of strategies to overcome issues with the high cost of recently introduced treatments; (3) special attention to special patient groups, such as HIV/HCV co-infection, hemophilia, thalassemia, hemodialysis, and liver-transplant patients; and (4) development of preventive strategies, such as the development of an efficient HCV vaccine, special attention to harm reduction in high-risk groups, and promotion of mass awareness of HCV. CONCLUSIONS The eradication of HCV will require significant governmental financial investment for screening, prevention, and treatment of infected patients. Although, we have a long way to eradication of HCV, the next steps could be including proper planning to patient finding, availability of new treatments to all patients and development of HCV prevention strategies such as vaccines.
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Affiliation(s)
- Khashayar Hesamizadeh
- Middle East Liver Disease (MELD) Center, Tehran, IR Iran
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Heidar Sharafi
- Middle East Liver Disease (MELD) Center, Tehran, IR Iran
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Saeid Rezaee-Zavareh
- Middle East Liver Disease (MELD) Center, Tehran, IR Iran
- Students’ Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Bita Behnava
- Middle East Liver Disease (MELD) Center, Tehran, IR Iran
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Seyed Moayed Alavian
- Middle East Liver Disease (MELD) Center, Tehran, IR Iran
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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