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Gelu-Simeon M, Lafrance MJ, Michineau L, Saillard E, Thomé JP, Emond C, Samson M, Multigner L. Inverse association between plasma chlordecone concentrations and progression of alcoholic liver fibrosis: the role of liver metabolism. Environ Health 2024; 23:30. [PMID: 38504260 PMCID: PMC10953091 DOI: 10.1186/s12940-024-01054-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/10/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND AND AIMS Chlordecone is a persistent organochlorinated insecticide, extensively used in the French West Indies and has been contaminating the population for more than thirty years. Its potentiation effect on hepatotoxic agents has been demonstrated in animal models. We investigated the relationship between environmental exposure to chlordecone and the progression of liver fibrosis. METHODS This study included 182 consecutive patients with chronic alcoholic hepatitis whose liver fibrosis was assessed using non-invasive methods. Measured plasma chlordecone concentrations at inclusion were used as surrogate of long-term exposure under steady-state conditions. As the pharmacokinetic processing of chlordecone is largely determined by the liver, we used a human physiologically based pharmacokinetic model to predict plausible changes in the steady-state blood chlordecone concentrations induced by liver fibrosis. RESULTS With a median follow-up of 27.1 years after the onset of alcohol consumption, we found a significant decrease in the risk of advanced liver fibrosis with increasing plasma chlordecone concentration (adjusted hazard ratio = 0.56; 95% confidence interval: 0.34-0.95 for the highest vs. lowest tertile, p = 0.04). Changes induced by liver fibrosis influenced the pharmacokinetic processing of chlordecone, resulting in substantial modifications in its steady-state blood concentrations. CONCLUSION According to this human model of coexposure to alcohol, reverse causality is the most plausible explanation of this inverse association between plasma chlordecone concentrations and progression of liver fibrosis. This study underlines the importance of considering the pharmacokinetic of environmental contaminants in epidemiological studies when biomarkers of exposure are used to investigate their own impact on the liver. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03373396.
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Affiliation(s)
- Moana Gelu-Simeon
- CHU de la Guadeloupe, Univ Antilles, Inserm, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Route de Chauvel, Pointe-à-Pitre Cedex, Guadeloupe, 97159, France.
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Guadeloupe, Pointe à Pitre, Guadeloupe, France.
| | - Marie-Josée Lafrance
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Guadeloupe, Pointe à Pitre, Guadeloupe, France
| | - Leah Michineau
- Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Avenue du Professeur Léon Bernard, Rennes, F-35000, France
| | - Eric Saillard
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Guadeloupe, Pointe à Pitre, Guadeloupe, France
| | - Jean Pierre Thomé
- Université de Liège, LEAE -CART, Freshwater and Oceanic Sciences Unit of Research (FOCUS), B6C, Liège, 4000, Belgium
| | - Claude Emond
- PKSH Inc, Crabtree, QC, Canada
- École de Santé Publique, Département de Santé Environnementale et Santé au Travail (DSEST), Université de Montréal, Montreal, QC, Canada
| | - Michel Samson
- Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Avenue du Professeur Léon Bernard, Rennes, F-35000, France.
| | - Luc Multigner
- Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Avenue du Professeur Léon Bernard, Rennes, F-35000, France
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Barré T, Carrat F, Ramier C, Fontaine H, Di Beo V, Bureau M, Dorival C, Larrey D, Delarocque-Astagneau E, Mathurin P, Marcellin F, Petrov-Sanchez V, Cagnot C, Carrieri P, Pol S, Protopopescu C, Alric L, Pomes C, Zoulim F, Maynard M, Bai R, Hucault L, Bailly F, Raffi F, Billaud E, Boutoille D, Lefebvre M, André-Garnier E, Cales P, Hubert I, Lannes A, Lunel F, Boursier J, Asselah T, Boyer N, Giuily N, Castelnau C, Scoazec G, Pol S, Fontaine H, Rousseaud E, Vallet-Pichard A, Sogni P, de Ledinghen V, Foucher J, Hiriart JB, M’Bouyou J, Irlès-Depé M, Bourlière M, Ahmed SNS, Oules V, Tran A, Anty R, Gelsi E, Truchi R, Thabut D, Hammeche S, Moussali J, Causse X, De Dieuleveult B, Ouarani B, Labarrière D, Ganne N, Grando-Lemaire V, Nahon P, Brulé S, Ulker B, Guyader D, Jezequel C, Brener A, Laligant A, Rabot A, Renard I, Habersetzer F, Baumert TF, Doffoel M, Mutter C, Simo-Noumbissie P, Razi E, Bronowicki JP, Barraud H, Bensenane M, Nani A, Hassani-Nani S, Bernard MA, Pageaux GP, Larrey D, Meszaros M, Metivier S, Bureau C, Morales T, Peron JM, Robic MA, Decaens T, Faure M, Froissart B, Hilleret MN, Zarski JP, Riachi G, Goria O, Paris F, Montialoux H, Leroy V, Amaddeo G, Varaut A, Simoes M, Amzal R, Chazouillières O, Andreani T, Angoulevant B, Chevance A, Serfaty L, Samuel D, Antonini T, Coilly A, Duclos-Vallée JC, Tateo M, Abergel A, Reymond M, Brigitte C, Benjamin B, Muti L, Geist C, Conroy G, Riffault R, Rosa I, Barrault C, Costes L, Hagège H, Loustaud-Ratti V, Carrier P, Debette-Gratien M, Mathurin P, Lassailly G, Lemaitre E, Canva V, Dharancy S, Louvet A, Minello A, Latournerie M, Bardou M, Mouillot T, D’Alteroche L, Barbereau D, Nicolas C, Elkrief L, Jaillais A, Gournay J, Chevalier C, Archambeaud I, Habes S, Portal I, Gelu-Simeon M, Saillard E, Lafrance MJ, Catherine L, Carrat F, Chau F, Dorival C, Goderel I, Lusivika-Nzinga C, Bellance MA, Bellet J, Monfalet P, Chane-Teng J, Bijaoui S, Pannetier G, Téoulé F, Nicol J, Sebal F, Bekhti R, Cagnot C, Boston A, Nailler L, Le Meut G, Diallo A, Petrov-Sanchez V, Bourlière M, Boursier J, Carrat F, Carrieri P, Delarocque-Astagneau E, De Ledinghen V, Dorival C, Fontaine H, Fourati S, Housset C, Larrey D, Nahon P, Pageaux GP, Petrov-Sanchez V, Pol S, Bruyand M, Wittkop L, Zoulim F, Zucman-Rossi J, L’hennaff M, Sizorn M, Cagnot C. Cannabis use as a factor of lower corpulence in hepatitis C-infected patients: results from the ANRS CO22 Hepather cohort. J Cannabis Res 2022; 4:31. [PMID: 35690798 PMCID: PMC9188079 DOI: 10.1186/s42238-022-00138-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background Patients with chronic hepatitis C virus (HCV) infection are at greater risk of developing metabolic disorders. Obesity is a major risk factor for these disorders, and therefore, managing body weight is crucial. Cannabis use, which is common in these patients, has been associated with lower corpulence in various populations. However, this relationship has not yet been studied in persons with chronic HCV infection. Methods Using baseline data from the French ANRS CO22 Hepather cohort, we used binary logistic and multinomial logistic regression models to test for an inverse relationship between cannabis use (former/current) and (i) central obesity (i.e., large waist circumference) and (ii) overweight and obesity (i.e., elevated body mass index (BMI)) in patients from the cohort who had chronic HCV infection. We also tested for relationships between cannabis use and both waist circumference and BMI as continuous variables, using linear regression models. Results Among the 6348 participants in the study population, 55% had central obesity, 13.7% had obesity according to their BMI, and 12.4% were current cannabis users. After multivariable adjustment, current cannabis use was associated with lower risk of central obesity (adjusted odds ratio, aOR [95% confidence interval, CI]: 0.45 [0.37–0.55]), BMI-based obesity (adjusted relative risk ratio (aRRR) [95% CI]: 0.27 [0.19–0.39]), and overweight (aRRR [95% CI]: 0.47 [0.38–0.59]). This was also true for former use, but to a lesser extent. Former and current cannabis use were inversely associated with waist circumference and BMI. Conclusions We found that former and, to a greater extent, current cannabis use were consistently associated with smaller waist circumference, lower BMI, and lower risks of overweight, obesity, and central obesity in patients with chronic HCV infection. Longitudinal studies are needed to confirm these relationships and to assess the effect of cannabis use on corpulence and liver outcomes after HCV cure. Trial registration ClinicalTrials.gov identifier: NCT01953458.
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Dereeper A, Gruel G, Pot M, Couvin D, Barbier E, Bastian S, Bambou JC, Gelu-Simeon M, Ferdinand S, Guyomard-Rabenirina S, Passet V, Martino F, Piveteau P, Reynaud Y, Rodrigues C, Roger PM, Roy X, Talarmin A, Tressieres B, Valette M, Brisse S, Breurec S. Limited Transmission of Klebsiella pneumoniae among Humans, Animals, and the Environment in a Caribbean Island, Guadeloupe (French West Indies). Microbiol Spectr 2022; 10:e0124222. [PMID: 36094181 PMCID: PMC9603589 DOI: 10.1128/spectrum.01242-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/08/2022] [Indexed: 12/30/2022] Open
Abstract
Guadeloupe (French West Indies), a Caribbean island, is an ideal place to study the reservoirs of the Klebsiella pneumoniae species complex (KpSC) and identify the routes of transmission between human and nonhuman sources due to its insularity, small population size, and small area. Here, we report an analysis of 590 biological samples, 546 KpSC isolates, and 331 genome sequences collected between January 2018 and May 2019. The KpSC appears to be common whatever the source. Extended-spectrum-β-lactamase (ESBL)-producing isolates (21.4%) belonged to K. pneumoniae sensu stricto (phylogroup Kp1), and all but one were recovered from the hospital setting. The distribution of species and phylogroups across the different niches was clearly nonrandom, with a distinct separation of Kp1 and Klebsiella variicola (Kp3). The most frequent sequence types (STs) (≥5 isolates) were previously recognized as high-risk multidrug-resistant (MDR) clones, namely, ST17, ST307, ST11, ST147, ST152, and ST45. Only 8 out of the 63 STs (12.7%) associated with human isolates were also found in nonhuman sources. A total of 22 KpSC isolates were defined as hypervirulent: 15 associated with human infections (9.8% of all human isolates), 4 (8.9%) associated with dogs, and 3 (15%) associated with pigs. Most of the human isolates (33.3%) belonged to the globally successful sublineage CG23-I. ST86 was the only clone shared by a human and a nonhuman (dog) source. Our work shows the limited transmission of KpSC isolates between human and nonhuman sources and points to the hospital setting as a cornerstone of the spread of MDR clones and antibiotic resistance genes. IMPORTANCE In this study, we characterized the presence and genomic features of isolates of the Klebsiella pneumoniae species complex (KpSC) from human and nonhuman sources in Guadeloupe (French West Indies) in order to identify the reservoirs and routes of transmission. This is the first study in an island environment, an ideal setting that limits the contribution of external imports. Our data showed the limited transmission of KpSC isolates between the different compartments. In contrast, we identified the hospital setting as the epicenter of antibiotic resistance due to the nosocomial spread of successful multidrug-resistant (MDR) K. pneumoniae clones and antibiotic resistance genes. Ecological barriers and/or limited exposure may restrict spread from the hospital setting to other reservoirs and vice versa. These results highlight the need for control strategies focused on health care centers, using genomic surveillance to limit the spread, particularly of high-risk clones, of this important group of MDR pathogens.
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Affiliation(s)
- Alexis Dereeper
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
| | - Gaëlle Gruel
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
| | - Matthieu Pot
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
| | - David Couvin
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
| | - Elodie Barbier
- UMR AgroEcologie, INRAE, Bourgogne Franche-Comté University, Dijon, France
| | - Sylvaine Bastian
- Laboratory of Clinical Microbiology, University Hospital Center of Guadeloupe, Pointe-à-Pitre/Les Abymes, France
| | | | - Moana Gelu-Simeon
- Hepato-Gastroenterology Department, University Hospital Center of Guadeloupe, Pointe-à-Pitre/Les Abymes, France
| | - Séverine Ferdinand
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
| | | | - Virginie Passet
- Institut Pasteur, University Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Frederic Martino
- Intensive Care Department, University Hospital Center of Guadeloupe, Pointe-à-Pitre/Les Abymes, France
| | | | - Yann Reynaud
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
| | - Carla Rodrigues
- Institut Pasteur, University Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Pierre-Marie Roger
- Infectious Disease Department, University Hospital Center of Guadeloupe, Pointe-à-Pitre/Les Abymes, France
- Faculty of Medecine Hyacinthe Bastaraud, University of the Antilles, Pointe-à-Pitre, France
| | - Xavier Roy
- Veterinary Clinic, Baie-Mahault, Guadeloupe
| | - Antoine Talarmin
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
| | - Benoit Tressieres
- INSERM Center for Clinical Investigation 1424, Pointe-à-Pitre/Les Abymes, France
| | - Marc Valette
- Intensive Care Department, University Hospital Center of Guadeloupe, Pointe-à-Pitre/Les Abymes, France
| | - Sylvain Brisse
- Institut Pasteur, University Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Sébastien Breurec
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
- Laboratory of Clinical Microbiology, University Hospital Center of Guadeloupe, Pointe-à-Pitre/Les Abymes, France
- Faculty of Medecine Hyacinthe Bastaraud, University of the Antilles, Pointe-à-Pitre, France
- INSERM Center for Clinical Investigation 1424, Pointe-à-Pitre/Les Abymes, France
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Carrieri P, Carrat F, Di Beo V, Bourlière M, Barré T, De Ledinghen V, Pageaux GP, Bureau M, Cagnot C, Dorival C, Delarocque-Astagneau E, Marcellin F, Pol S, Fontaine H, Protopopescu C, Laurent Alric, Bonnet D, Payssan-Sicart V, Pomes C, Zoulim F, Maynard M, Bai R, Hucault L, Bailly F, Raffi F, Billaud E, Boutoille D, Lefebvre M, André-Garnier E, Cales P, Hubert I, Lannes A, Lunel F, Boursier J, Asselah T, Boyer N, Giuily N, Castelnau C, Scoazec G, Pol S, Fontaine H, Rousseaud E, Vallet-Pichard A, Sogni P, de Ledinghen V, Foucher J, Hiriart JB, M’Bouyou J, Irlès-Depé M, Bourlière M, Si Ahmed SN, Oules V, Tran A, Anty R, Gelsi E, Truchi R, Thabut D, Hammeche S, Moussali J, Causse X, De Dieuleveult B, Ouarani B, Labarrière D, Ganne N, Grando-Lemaire V, Nahon P, Brulé S, Ulker B, Guyader D, Jezequel C, Brener A, Laligant A, Rabot A, Renard I, Habersetzer F, Baumert TF, Doffoel M, Mutter C, Simo-Noumbissie P, Razi E, Bronowicki JP, Barraud H, Bensenane M, Nani A, Hassani-Nani S, Bernard MA, Pageaux GP, Larrey D, Meszaros M, Metivier S, Bureau C, Morales T, Peron JM, Robic MA, Decaens T, Froissart B, Hilleret MN, Costentin C, Gerster T, Riachi G, Goria O, Paris F, Montialoux H, Leroy V, Amaddeo G, Varaut A, Simoes M, Amzal R, Chazouillières O, Andreani T, Angoulevant B, Chevance A, Serfaty L, Duclos Vallée JC, Samuel D, Antonini T, Coilly A, Tateo M, Abergel A, Reymond M, Brigitte C, Benjamin B, Muti L, Geist C, Conroy G, Riffault R, Rosa I, Barrault C, Costes L, Hagège H, Loustaud-Ratti V, Carrier P, Debette-Gratien M, Mathurin P, Lassailly G, Lemaitre E, Canva V, Dharancy S, Louvet A, Minello A, Latournerie M, Bardou M, Mouillot T, D’Alteroche L, Barbereau D, Nicolas C, Elkrief L, Jaillais A, Gournay J, Chevalier C, Archambeaud I, Habes S, Portal I, Gelu-Simeon M, Saillard E, Lafrance MJ, Catherine L, Carrat F, Chau F, Dorival C, Goderel I, Lusivika-Nzinga C, Bellance MA, Bellet J, Monfalet P, Chane-Teng J, Bijaoui S, Pannetier G, Téoulé F, Nicol J, Bekhti R, Cagnot C, Boston A, Nailler L, Le Meut G, Diallo A, Petrov-Sanchez V, Marc Bourlière, Boursier J, Carrat F, Carrieri P, Delarocque-Astagneau E, De Ledinghen V, Dorival C, Fontaine H, Fourati S, Housset C, Larrey D, Nahon P, Pageaux GP, Petrov-Sanchez V, Pol S, Bruyand M, Wittkop L, Zoulim F, Zucman-Rossi J, L’hennaff M, Sizorn M, Boston A, Diallo A, Cagnot C, Bousselet A, Caralp M. Severe liver fibrosis in the HCV cure era: major effects of social vulnerability, diabetes, and unhealthy behaviors. JHEP Rep 2022; 4:100481. [PMID: 35514789 PMCID: PMC9065909 DOI: 10.1016/j.jhepr.2022.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/08/2022] [Accepted: 02/24/2022] [Indexed: 11/06/2022] Open
Abstract
Background & Aims After HCV cure, not all patients achieve significant liver fibrosis regression. We explored the effects of clinical and socio-behavioral factors on liver fibrosis, before and after HCV cure with direct-acting antivirals. Methods We analyzed data from the ongoing ANRS CO22 HEPATHER cohort, which prospectively collects clinical and socio-behavioral data on HCV-infected patients. Mixed-effects logistic regression models helped identify predictors of longitudinal measures of severe liver fibrosis, defined as a fibrosis-4 index >3.25. We also estimated the adjusted population attributable fractions (PAFs) for modifiable risk factors. Results Among the 9,692 study patients (accounting for 24,687 visits over 4 years of follow-up, 48.5% of which were post-HCV cure), 26% had severe fibrosis at enrolment. After multivariable adjustment, HCV-cured patients had an 87% lower risk of severe fibrosis. An inverse dose-response relationship was found for coffee consumption, with the risk of severe fibrosis diminishing by 58% per additional cup/day (adjusted odds ratio (aOR 0.42; 95% CI 0.38-0.46). Unemployment, low educational level, and diabetes were associated with a higher severe fibrosis risk (aOR 1.69; 95% CI 1.32-2.16, aOR 1.50; 95% CI 1.20-1.86, and aOR 4.27; 95% CI 3.15-5.77, respectively). Severe fibrosis risk was 3.6/4.6-fold higher in individuals with previous/current unhealthy alcohol use than in abstinent patients. All these associations remained valid after HCV cure. The risk factors accounting for the greatest severe fibrosis burden were unemployment, low education level, and diabetes (PAFs: 29%, 21%, and 17%, respectively). Conclusions Monitoring liver fibrosis after HCV cure is crucial for patients with low socioeconomic status, previous/current unhealthy alcohol use, and diabetes. Innovative HCV care models for the most socially vulnerable individuals and interventions for healthier lifestyles are needed to reinforce the positive effects of HCV cure on liver health. Lay summary After hepatitis C virus (HCV) cure, not all patients achieve significant liver fibrosis regression. Herein, we studied the effects of clinical and socio-behavioral factors on the risk of severe liver fibrosis. Coffee consumption was strongly inversely associated with severe fibrosis, while diabetes, previous and current unhealthy alcohol use were associated with a 4.3-, 3.6- and 4.6-fold higher risk of severe fibrosis, respectively. Unemployment and low educational level were also associated with a higher risk of severe fibrosis. All these associations remained valid after HCV cure. These results demonstrate the need to continue liver fibrosis monitoring in at-risk groups, and to facilitate healthier lifestyles after HCV cure as a clinical and public health priority. Liver fibrosis assessment is a key prognostic tool in the hepatitis C cure era. Significant liver fibrosis regression does not always occur after hepatitis C cure. Coffee intake displays protective effects on severe fibrosis even after HCV cure. Social vulnerability, diabetes, and unhealthy alcohol use predict severe fibrosis. Socio-behavioral factors are associated with severe fibrosis even after HCV cure.
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Pageaux GP, Nzinga CL, Ganne N, Samuel D, Dorival C, Zoulim F, Cagnot C, Decaens T, Thabut D, Asselah T, Mathurin P, Habersetzer F, Bronowicki JP, Guyader D, Rosa I, Leroy V, Chazouilleres O, de Ledinghen V, Bourliere M, Causse X, Cales P, Metivier S, Loustaud-Ratti V, Riachi G, Alric L, Gelu-Simeon M, Minello A, Gournay J, Geist C, Tran A, Abergel A, Portal I, d'Alteroche L, Raffi F, Fontaine H, Carrat F, Pol S. Clinical outcomes after treatment with direct antiviral agents: beyond the virological response in patients with previous HCV-related decompensated cirrhosis. BMC Infect Dis 2022; 22:94. [PMID: 35086481 PMCID: PMC8796427 DOI: 10.1186/s12879-022-07076-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background In HCV-infected patients with advanced liver disease, the direct antiviral agents-associated clinical benefits remain debated. We compared the clinical outcome of patients with a previous history of decompensated cirrhosis following treatment or not with direct antiviral agents from the French ANRS CO22 HEPATHER cohort. Methods We identified HCV patients who had experienced an episode of decompensated cirrhosis. Study outcomes were all-cause mortality, liver-related or non-liver-related deaths, hepatocellular carcinoma, liver transplantation. Secondary study outcomes were sustained virological response and its clinical benefits. Results 559 patients met the identification criteria, of which 483 received direct antiviral agents and 76 remained untreated after inclusion in the cohort. The median follow-up time was 39.7 (IQR: 22.7–51) months. After adjustment for multivariate analysis, exposure to direct antiviral agents was associated with a decrease in all-cause mortality (HR 0.45, 95% CI 0.24–0.84, p = 0.01) and non-liver-related death (HR 0.26, 95% CI 0.08–0.82, p = 0.02), and was not associated with liver-related death, decrease in hepatocellular carcinoma and need for liver transplantation. The sustained virological response was 88%. According to adjusted multivariable analysis, sustained virological response achievement was associated with a decrease in all-cause mortality (HR 0.29, 95% CI 0.15–0.54, p < 0.0001), liver-related mortality (HR 0.40, 95% CI 0.17–0.96, p = 0.04), non-liver-related mortality (HR 0.17, 95% CI 0.06–0.49, p = 0.001), liver transplantation (HR 0.17, 95% CI 0.05–0.54, p = 0.003), and hepatocellular carcinoma (HR 0.52, 95% CI 0.29–0.93, p = 0.03). Conclusion Treatment with direct antiviral agents is associated with reduced risk for mortality. The sustained virological response was 88%. Thus, direct antiviral agents treatment should be considered for any patient with HCV-related decompensated cirrhosis. Trial registration: ClinicalTrials.gov registry number: NCT01953458. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07076-0.
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Affiliation(s)
- Georges-Philippe Pageaux
- Department of Hepatology and Gastroenterology, Centre Hospitalo-Universitaire Saint Eloi, Université de Montpellier, 34295, Montpellier, France.
| | - Clovis Lusivika Nzinga
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Nathalie Ganne
- Department of Hepatology, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Avicenne, AP-HP, Bobigny, France.,Université Paris 13, Sorbonne Paris Cité et INSERM UMR 1162, Paris, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, 94800, Villejuif, France.,Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies du Foie, 94800, Villejuif, France.,Inserm, Unité 1193, Université Paris-Saclay, Hepatinov, 94800, Villejuif, France
| | - Céline Dorival
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Fabien Zoulim
- Department of Hepatology, Hospices Civils de Lyon, INSERM U1052, Université de Lyon, Lyon, France
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, ANRS (France REcherche Nord&Sud Sida-Vih Hépatites), Paris, France
| | - Thomas Decaens
- Université Grenoble Alpes, 38000, Grenoble, France.,Institute for Advanced Biosciences, Research Center Inserm U1209, CNRS UMR5309, 38700, La Tronche, France.,Service d'hépatogastroentérologie, Pôle Digidune, CHU Grenoble Alpes, 38700, La Tronche, France
| | - Dominique Thabut
- Department of Hepatology and Gastroenterology, Groupe Hospitalier Pitié-Salpétrière, AP-HP, INSERM UMR-S938, Sorbonne Université, Paris, France
| | - Tarik Asselah
- INSERM UMR 1149, Hepatology, Hospital Beaujon, Centre de Recherche sur l'Inflammation, (CRI), University Paris Diderot, Clichy, France
| | - Philippe Mathurin
- Service des Maladies de l'appareil Digestif, Université Lille 2 and Inserm U795, Lille, France
| | - François Habersetzer
- CIC, Inserm 1110 et Pôle Hépato-digestif des Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Jean-Pierre Bronowicki
- Inserm U1254 and Department of Hepato-Gastroenterology, University Hospital of Nancy Brabois, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Dominique Guyader
- CHU de Rennes, Service d'hépatologie, 35033, Rennes, France.,Univ Rennes1, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR_A 1341, UMR_S 1241, 35033, Rennes, France
| | - Isabelle Rosa
- Department of Hepatology and Gastroenterology, Centre Hospitalier Intercommunal, Créteil, France
| | - Vincent Leroy
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, AP-HP, Université Paris-Est, INSERM U955, Créteil, France
| | - Olivier Chazouilleres
- Department of Hepatology, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Victor de Ledinghen
- Hepatology Unit Hôpital Haut-Lévêque, Pessac, INSERM U1053, Université Bordeaux Segalen, Bordeaux, France
| | - Marc Bourliere
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France
| | - Xavier Causse
- Department of Hepatology and Gastroenterology, CHR Orléans, Orléans, France
| | - Paul Cales
- Hepatology Department, University Hospital, Angers, France.,HIFIH Laboratory, Angers University, Angers, France
| | | | - Véronique Loustaud-Ratti
- Department of Hepatology and Gastroenterology, CHU Limoges, U1248 INSERM, Univ. Limoges, 87000, Limoges, France
| | - Ghassan Riachi
- Department of Hepatology and Gastroenterology, CHU Charles Nicolle, Rouen, France
| | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, CHU Purpan, UMR 152 Pharma Dev, IRD Toulouse 3 University, Toulouse, France
| | - Moana Gelu-Simeon
- Service d'Hépato-Gastroentérologie, CHU de la Guadeloupe-Faculté de Médecine, Université des Antilles, 97110, Pointe-à-Pitre Cedex, France.,INSERM, UMR-S1085/IRSET, 35043, Rennes, France
| | - Anne Minello
- Department of Hepatology and Gastroenterology, University Hospital Dijon, INSERM UMR 1231, Dijon, France
| | - Jérôme Gournay
- Gastroenterology and Hepatology Department, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes, France
| | - Claire Geist
- Department of Hepatology and Gastroenterology, Centre Hospitalier Régional, Metz, France
| | - Albert Tran
- Digestive Center, Centre Hospitalier Universitaire de Nice, INSERM U1065-8, Nice, France
| | - Armand Abergel
- Department of Digestive and Hepatobiliary Diseases, Estaing University Hospital, Clermont-Ferrand, France.,UMR 6602 CNRS-Sigma-Université Clermont Auvergne, Clermont-Ferrand, France
| | - Isabelle Portal
- Service d'Hépato-Gastroentérologie, Hôpital de la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - Louis d'Alteroche
- Unit of Hepatology, Hépatogastroentérologie, CHU Trousseau, 37044, Tours, France
| | - François Raffi
- Department of Infectious Diseases, Hotel-Dieu Hospital-INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Hélène Fontaine
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Unité d'Hépatologie, Paris, France
| | - Fabrice Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Stanislas Pol
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France.,Université Paris Descartes, Paris, France.,INSERM U-1223 et USM20, Institut Pasteur, Paris, France
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Lam L, Fontaine H, Bourliere M, Lusivika-Nzinga C, Dorival C, Thabut D, Zoulim F, Habersetzer F, Asselah T, Duclos-Vallee JC, Bronowicki JP, Mathurin P, Decaens T, Ganne N, Guyader D, Leroy V, Rosa I, De Ledinghen V, Cales P, Causse X, Larrey D, Chazouilleres O, Gelu-Simeon M, Loustaud-Ratti V, Metivier S, Alric L, Riachi G, Gournay J, Minello A, Tran A, Geist C, Abergel A, Raffi F, D'Alteroche L, Portal I, Lapidus N, Pol S, Carrat F. Predictive factors for hepatocellular carcinoma in chronic hepatitis B using structural equation modeling: a prospective cohort study. Clin Res Hepatol Gastroenterol 2021; 45:101713. [PMID: 33930591 DOI: 10.1016/j.clinre.2021.101713] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS The factors predicting hepatocellular carcinoma (HCC) occurrence in chronic hepatitis B need to be precisely known to improve its detection. We identified pathways and individual predictive factors associated with HCC in the ANRS CO22 HEPATHER cohort. METHODS The study analyzed HBV-infected patients recruited at 32 French expert hepatology centers from August 6, 2012, to December 31, 2015. We excluded patients with chronic HCV, HDV and a history of HCC, decompensated cirrhosis or liver transplantation. Structural equation models were developed to characterize the causal pathways leading to HCC occurrence. The association between clinical characteristics (age, gender, body-mass index, liver fibrosis, alcohol consumption, smoking status, diabetes, hypertension, dyslipidemia, alpha-fetoprotein, HBV DNA levels, antiviral therapy) and incident HCC was quantified. RESULTS Among the 4489 patients included, 33 patients reported incident HCC. The median follow-up was 45.5 months. Age (β = 0.18 by decade, 95% CI 0.14-0.23), male gender (β = 0.23, 95% CI 0.18-0.29), metabolic syndrome (β = 0.28, 95% CI 0.22-0.33), alcohol consumption (β = 0.09, 95% CI 0.05-0.14) and HBV DNA (β = 0.25, 95% CI 0.170.34) had a significant and direct effect on the occurrence of advanced liver fibrosis. Liver fibrosis (β = 0.71, 95% CI 0.55-0.87) predicted, in turn, the occurrence of HCC. CONCLUSIONS Liver fibrosis mediates the effects of age, gender, alcohol, metabolic syndrome and HBV DNA on the occurrence of HCC. Elderly men with chronic hepatitis B, risky alcohol use, advanced liver fibrosis, metabolic syndrome and high HBV DNA levels should be monitored closely to detect the development of HCC.
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Affiliation(s)
- Laurent Lam
- Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Department of Public Health, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Hélène Fontaine
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Marc Bourliere
- Department of Hepatology and Gastroenterology, Hôpital Saint-Joseph, Marseille, France
| | - Clovis Lusivika-Nzinga
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Céline Dorival
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Dominique Thabut
- Sorbonne Université, Department of Hepatology and Gastroenterology, Groupe Hospitalier Pitié-Salpétrière, AP-HP, INSERM UMR-S938, Paris, France
| | - Fabien Zoulim
- Department of Hepatology, Hospices Civils de Lyon, INSERM U1052, Université de Lyon, Lyon, France
| | - François Habersetzer
- CIC, Inserm 1110 et Pôle Hépato-digestif des Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Tarik Asselah
- INSERM UMR 1149, Hepatology, Hospital Beaujon, Centre de Recherche sur l'Inflammation, (CRI), University Paris Diderot, Clichy, France
| | - Jean-Charles Duclos-Vallee
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, UMR-S 1193, Université Paris-Saclay, DHU HEPATINOV, Villejuif, France
| | - Jean-Pierre Bronowicki
- Inserm U1254 and Department of Hepato-Gastroenterology, University Hospital of Nancy Brabois, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Philippe Mathurin
- Service des Maladies de l'Appareil Digestif, Université Lille 2 and Inserm U795, France
| | - Thomas Decaens
- Department of Hepatology and Gastroenterology, Centre Hospitalo-Universitaire, INSERM U1209, Université Grenoble Alpes, Grenoble, France
| | - Nathalie Ganne
- Department of Hepatology, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Jean Verdier, AP-HP, Bondy, France; Université Paris 13, Sorbonne Paris Cité et INSERM UMR 1162, Paris, France
| | - Dominique Guyader
- CHU de Rennes, Service d'Hépatologie, Univ Rennes 1, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR A 1341, UMR S 1241, F-35033 Rennes, France
| | - Vincent Leroy
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, AP-HP, Université Paris-Est, INSERM U955, Créteil, France
| | - Isabelle Rosa
- Department of Hepatology and Gastroenterology, Centre Hospitalier Intercommunal, Créteil, France
| | - Victor De Ledinghen
- Hepatology Unit, University Hospital Bordeaux and INSERM U1053, Bordeaux University, Pessac, France
| | - Paul Cales
- Hepatology Department, University Hospital, Angers, France; HIFIH Laboratory, Angers University, Angers, France
| | - Xavier Causse
- Department of Hepatology and Gastroenterology, CHR Orléans, France
| | - Dominique Larrey
- Liver Unit-IRB-INSERM 1183, Hôpital Saint Eloi, Montpellier, France
| | - Olivier Chazouilleres
- Department of Hepatology, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Moana Gelu-Simeon
- Service d'Hépato-Gastroentérologie, CHU de la Guadeloupe - Faculté de Médecine, Université des Antilles, Pointe-à-Pitre Cedex, F-97110, France - INSERM, UMR-S1085/IRSET, F-35043 Rennes, France
| | - Véronique Loustaud-Ratti
- Department of Hepatology and Gastroenterology, CHU Limoges, U1248 INSERM, Univ. Limoges, F-87000 Limoges, France
| | | | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, CHU Purpan, UMR 152 Pharma Dev, IRD Toulouse 3 University, France
| | - Ghassan Riachi
- Department of Hepatology and Gastroenterology, CHU Charles Nicolle, Rouen, France
| | - Jérôme Gournay
- Gastroenterology and Hepatology Department, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes, France
| | - Anne Minello
- Department of Hepatology and Gastroenterology, University Hospital Dijon, INSERM UMR 1231, France
| | - Albert Tran
- Digestive Center, Centre Hospitalier Universitaire de Nice, INSERM U1065-8, Nice, France
| | - Claire Geist
- Department of Hepatology and Gastroenterology, Centre Hospitalier Régional, Metz, France
| | - Armand Abergel
- Department of Digestive and Hepatobiliary Diseases, Estaing University Hospital, Clermont-Ferrand, France; UMR 6602 CNRS-Sigma-Université Clermont Auvergne, Clermont-Ferrand, France
| | - François Raffi
- Department of Infectious Diseases, Hotel-Dieu Hospital - INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Louis D'Alteroche
- Unit of Hepatology, Hépatogastroentérologie, CHU Trousseau, 37044 Tours, France
| | - Isabelle Portal
- Service d'Hépato-Gastroentérologie, Hôpital de la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - Nathanaël Lapidus
- Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Department of Public Health, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Stanislas Pol
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France; Université de Paris; Inserm U-1223 and ICD, Institut Pasteur, Paris, France
| | - Fabrice Carrat
- Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Department of Public Health, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.
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Ichai P, Gelu-Simeon M, Durand F, Samuel D, Bernuau J. Early N-acetylcysteine for hospitalised patients with yellow fever. Lancet Infect Dis 2019; 19:1055. [PMID: 31559956 DOI: 10.1016/s1473-3099(19)30478-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Philippe Ichai
- Liver Intensive Care Unit, Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul-Brousse, Villejuif F-94800, France.
| | - Moana Gelu-Simeon
- Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire Guadeloupe, Université des Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - François Durand
- Department of Hepatology and Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Clichy, France
| | - Didier Samuel
- Liver Intensive Care Unit, Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul-Brousse, Villejuif F-94800, France
| | - Jacques Bernuau
- Department of Hepatology and Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Clichy, France
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8
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Carrat F, Fontaine H, Dorival C, Simony M, Diallo A, Hezode C, De Ledinghen V, Larrey D, Haour G, Bronowicki JP, Zoulim F, Asselah T, Marcellin P, Thabut D, Leroy V, Tran A, Habersetzer F, Samuel D, Guyader D, Chazouilleres O, Mathurin P, Metivier S, Alric L, Riachi G, Gournay J, Abergel A, Cales P, Ganne N, Loustaud-Ratti V, D'Alteroche L, Causse X, Geist C, Minello A, Rosa I, Gelu-Simeon M, Portal I, Raffi F, Bourliere M, Pol S. Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. Lancet 2019; 393:1453-1464. [PMID: 30765123 DOI: 10.1016/s0140-6736(18)32111-1] [Citation(s) in RCA: 389] [Impact Index Per Article: 77.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/12/2018] [Accepted: 08/28/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although direct-acting antivirals have been used extensively to treat patients with chronic hepatitis C virus (HCV) infection, their clinical effectiveness has not been well reported. We compared the incidence of death, hepatocellular carcinoma, and decompensated cirrhosis between patients treated with direct-acting antivirals and those untreated, in the French ANRS CO22 Hepather cohort. METHODS We did a prospective study in adult patients with chronic HCV infection enrolled from 32 expert hepatology centres in France. We excluded 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. Co-primary study outcomes were incidence of all-cause mortality, hepatocellular carcinoma, and decompensated cirrhosis. The association between direct-acting antivirals and these outcomes was quantified using time-dependent Cox proportional hazards models. This study is registered with ClinicalTrials.gov, number NCT01953458. FINDINGS Between Aug 6, 2012, and Dec 31, 2015, 10 166 patients were eligible for the study. 9895 (97%) patients had available follow-up information and were included in analyses. Median follow-up was 33·4 months (IQR 24·0-40·7). Treatment with direct-acting antivirals was initiated during follow-up in 7344 patients, and 2551 patients remained untreated at the final follow-up visit. During follow-up, 218 patients died (129 treated, 89 untreated), 258 reported hepatocellular carcinoma (187 treated, 71 untreated), and 106 had decompensated cirrhosis (74 treated, 32 untreated). Exposure to direct-acting antivirals was 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). 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), exposure to direct-acting antivirals was associated with 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 was not associated with decompensated cirrhosis (1·14, 0·57-2·27). INTERPRETATION Treatment with direct-acting antivirals is associated with reduced risk for mortality and hepatocellular carcinoma and should be considered in all patients with chronic HCV infection. FUNDING INSERM-ANRS (France Recherche Nord & Sud Sida-HIV Hépatites), ANR (Agence Nationale de la Recherche), DGS (Direction Générale de la Santé), MSD, Janssen, Gilead, AbbVie, Bristol-Myers Squibb, and Roche.
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Affiliation(s)
- Fabrice Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France.
| | | | - Céline Dorival
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Mélanie Simony
- ANRS (France Recherche Nord & Sud Sida-HIV Hépatites), Unit for Basic and Clinical Research on Viral Hepatitis, Paris, France
| | - Alpha Diallo
- Clinical Trial Safety and Public Health, Paris, France
| | - Christophe Hezode
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, AP-HP, Université Paris-Est, INSERM U955, Créteil, France
| | - Victor De Ledinghen
- Hepatology Unit Hôpital Haut-Lévêque, Pessac, and INSERM U1053, Université Bordeaux Segalen, Bordeaux, France
| | - Dominique Larrey
- Liver Unit, Institute for Regenerative Medicine and Biotherapy-INSERM 1183, Hôpital Saint Eloi, Montpellier, France
| | - Georges Haour
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Jean-Pierre Bronowicki
- INSERM U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy Brabois, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Fabien Zoulim
- Department of Hepatology, Hospices Civils de Lyon, INSERM U1052, Université de Lyon, Lyon, France
| | - Tarik Asselah
- INSERM, Hepatology, Hospital Beaujon, Centre de Recherche sur l'Inflammation (CRI), University Paris Diderot, Clichy, France
| | - Patrick Marcellin
- INSERM, Hepatology, Hospital Beaujon, Centre de Recherche sur l'Inflammation (CRI), University Paris Diderot, Clichy, France
| | - Dominique Thabut
- Sorbonne Université, Department of Hepatology and Gastroenterology, Groupe Hospitalier Pitié-Salpétrière, AP-HP, INSERM Unité Mixte de Recherche (UMR)-S938, Paris, France
| | - Vincent Leroy
- Department of Hepatology and Gastroenterology, Centre Hospitalier Universitaire (CHU), INSERM U1209, Université Grenoble Alpes, Grenoble, France
| | - Albert Tran
- Digestive Centre, CHU de Nice, INSERM U1065-8, Nice, France
| | - François Habersetzer
- Centre d'Investigation Clinique (CIC), INSERM 1110, and Pôle Hépato-digestif des Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Université Paris-Sud, UMR-S1193, Université Paris-Saclay, and Hepatinov, Villejuif, France
| | - Dominique Guyader
- CHU de Rennes, Service d'Hépatologie, University Rennes 1, L'Institut National de la Recherche Agronomique (INRA), INSERM, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR-A1341, and UMR-S1241, Rennes, France
| | - Olivier Chazouilleres
- Department of Hepatology, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Philippe Mathurin
- Service des Maladies de l'Appareil Digestif, Université Lille 2, and INSERM U795, Lille, France
| | - Sophie Metivier
- Department of Hepatology and Gastroenterology, CHU Purpan, Toulouse, France
| | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, CHU Purpan, Toulouse, France; UMR 152 PHARMA-DEV (Pharmacochimie et Biologie pour le Développement), Institut de Recherche pour le Développement (IRD)-Université Toulouse 3, Toulouse, France
| | - Ghassan Riachi
- Department of Hepatology and Gastroenterology, CHU Charles Nicolle, Rouen, France
| | - Jérôme Gournay
- Gastroenterology and Hepatology Department, Institut des Maladies de l'Appareil Digestif, University Hospital Nantes, Nantes, France
| | - Armand Abergel
- Department of Digestive and Hepatobiliary Diseases, Estaing University Hospital, and UMR Auvergne University, Centre National de la Recherche Scientifique (CNRS) 6284 ISIT (Image Sciences for Innovations Techniques), Clermont-Ferrand, France
| | - Paul Cales
- Hepatology Department, University Hospital, Angers, France; Hémodynamique, Interaction Fibrose et Invasivité Tumorales Hépatiques (HIFIH) Laboratory, Bretagne Loire University, Angers, France
| | - Nathalie Ganne
- Department of Hepatology, Hôpitaux Universitaires Paris Seine-Saint-Denis, site Jean Verdier, AP-HP, Bondy, France; Université Paris 13, Sorbonne Paris Cité et INSERM UMR 1162, Paris, France
| | - Véronique Loustaud-Ratti
- Department of Hepatology and Gastroenterology, CHU Limoges, INSERM U1248, Université de Limoges, Limoges, France
| | - Louis D'Alteroche
- Unit of Hepatology, Hépatogastroentérologie, CHU Trousseau, Tours, France
| | - Xavier Causse
- Department of Hepatology and Gastroenterology, Centre Hospitalier Régional (CHR), Orléans, France
| | - Claire Geist
- Department of Hepatology and Gastroenterology, CHR, Metz, France
| | - Anne Minello
- Department of Hepatology and Gastroenterology, University Hospital Dijon, INSERM UMR 1231, Dijon, France
| | - Isabelle Rosa
- Department of Hepatology and Gastroenterology, Centre Hospitalier Intercommunal, Créteil, France
| | - Moana Gelu-Simeon
- Service d'Hépato-Gastroentérologie, CHU de Pointe-à-Pitre, and Faculté de Médecine, Université des Antilles, Pointe-à-Pitre, Guadeloupe, France; INSERM, UMR-S1085, Institut de Recherche en Santé, Environnement et Travail (IRSET), Rennes, France
| | - Isabelle Portal
- Service d'Hépato-Gastroentérologie, Hôpital de la Timone, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - François Raffi
- Department of Infectious Diseases, Hotel-Dieu Hospital, INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Marc Bourliere
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France
| | - Stanislas Pol
- AP-HP, Hôpital Cochin, Unité d'Hépatologie, Paris, France; Université Paris Descartes, INSERM U1223 and USM-20, Institut Pasteur, Paris, France
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9
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Gelu-Simeon M, Lewin M, Ostos M, Bayan T, Beso Delgado M, Teicher E, Layese R, Roudot-Thoraval F, Fontaine H, Sobesky R, Salmon-Céron D, Samuel D, Seror O, Nahon P, Meyer L, Duclos-Vallée JC. Prognostic factors of survival in HIV/HCV co-infected patients with hepatocellular carcinoma: The CARCINOVIC Cohort. Liver Int 2019; 39:136-146. [PMID: 29947467 DOI: 10.1111/liv.13921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 06/15/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS HIV/HCV co-infected patients with hepatocellular carcinoma (HCC) have poorer survival than HCV mono-infected patients. We aimed to evaluate the prognostic factors for survival. METHODS From 2006 to 2013, 55 incident HCCs among HIV+/HCV+ patients, from three ANRS cohorts, were compared with 181 HCCs in HIV-/HCV+ patients from the ANRS Cirvir cohort. RESULTS HIV+/HCV+ patients were younger (50 years [IQR: 47-53] vs 62 [54-70], P < 0.001), male (89% vs 63%, P < 0.001) than HIV-/HCV+ patients. At HCC diagnosis, both groups had a majority of non-responders to anti-HCV-therapy, and HIV+/HCV+ patients had more frequently known a previous cirrhosis decompensation (31% vs 14%, P = 0.005). At diagnostic imaging, there were more infiltrative forms of HCC in HIV+/HCV+ group (24% vs 14%, P < 0.001), associated with tumour portal thrombosis in 29%. During a median follow-up period of 11.96 [5.51-27] months since HCC diagnosis, a majority of palliative treatments were decided in HIV+/HCV+ patients (51% vs 19%, P < 0.001). The 1 and 2-year crude survival rates were 61% versus 78% and 47% versus 63%, P = 0.003 respectively. In a Cox model multivariate analysis adjusted for the cohort, age and sex, the most important prognostic factor for survival was the infiltrative form of the tumour (aRR: 8.10 [4.17-15.75], P < 0.001). CONCLUSIONS The radiological aggressiveness of the tumour is the best prognostic factor associated with poorer survival of HCC in HIV+/HCV+ patients. High α-foetoprotein level and decompensated cirrhosis are other ones. This justifies a particular attention to the detection and the management of small nodules in this high-risk population.
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Affiliation(s)
- Moana Gelu-Simeon
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,CHU de Guadeloupe, Service d'Hépato-Gastro-Entérologie, Faculté de Médecine Hyacinthe Bastaraud, Université Antilles-Guyane, Guadeloupe, France.,Inserm-UMR-S1085/IRSET, Rennes, France
| | - Maïté Lewin
- DHU Hepatinov, Villejuif, France.,Service de Radiologie, AP-HP Hôpital Paul-Brousse, Villejuif, France.,Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Maria Ostos
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Tatiana Bayan
- Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Inserm-CESP-UMR1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Maria Beso Delgado
- Inserm-CESP-UMR1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Elina Teicher
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Service de Médecine Interne, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Richard Layese
- AP-HP Hôpital Henri Mondor, URC-CEpiA-EA7376, Université Paris Est, Créteil, France
| | | | - Hélène Fontaine
- Unité d'Hépatologie, AP-HP Hôpital Cochin, USM20, Institut Pasteur, Université Paris-Descartes, Paris, France
| | - Rodolphe Sobesky
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Inserm-UMR1193, Université Paris-Saclay, Villejuif, France
| | - Dominique Salmon-Céron
- Service des Maladies Infectieuses et Tropicales, AP-HP Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Didier Samuel
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Inserm-UMR1193, Université Paris-Saclay, Villejuif, France
| | - Olivier Seror
- Service de Radiologie, AP-HP Hôpital Jean Verdier, Université Paris13, Bondy, France
| | - Pierre Nahon
- Service d'Hépato-Gastro-Entérologie, AP-HP Hôpital Jean Verdier, Bondy, France.,Bobigny, Inserm-UMR1162, Université Paris13, Paris, France
| | - Laurence Meyer
- Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Inserm-CESP-UMR1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Service de Santé Publique, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean-Charles Duclos-Vallée
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Inserm-UMR1193, Université Paris-Saclay, Villejuif, France
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10
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Gelu-Simeon M, Mathurin P. [Alcoholic hepatitis]. Rev Prat 2018; 68:1113-1118. [PMID: 30869221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Alcoholic hepatitis. In a context of chronic alcoholic intoxication, the diagnosis of alcoholic hepatitis (AH) relies on a histological definition. When it is symptomatic, AH is a clinical syndrome associating jaundice, moderate fever, sensitivity of the right upper quadrant, loss of appetite and signs of hepatocellular insufficiency in severe forms. Typical biological tests show a moderate cytolysis with predominant AST, a high level of ãGT, and leukocytosis on neutrophils. Rising level of bilirubin and INR rates and low TP ratio are markers of severity of the disease. Regardless, the initial severity, abstinence has a decisive influence on long-term survival. In severe forms (Maddrey ≥ 32), corticosteroid for one month improves short-term survival, which response is evaluated by the Lille score. Accelerated procedure liver transplantation may be offered to some non-responders to medical treatment.
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Affiliation(s)
- Moana Gelu-Simeon
- Service d'hépatogastro- entérologie, CHU de Guadeloupe, université des Antilles, Guadeloupe, France. Inserm, UMR-S 1085/IRSET, Rennes, France
| | - Philippe Mathurin
- Service des maladies de l'appareil digestif, hôpital Claude- Huriez, université Lille-2, Inserm U795, Lille, France
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11
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Tabet E, Gelu-Simeon M, Genet V, Lamontagne L, Piquet-Pellorce C, Samson M. Chlordecone potentiates auto-immune hepatitis and promotes brain entry of MHV3 during viral hepatitis in mouse models. Toxicol Lett 2018; 299:129-136. [PMID: 30287270 DOI: 10.1016/j.toxlet.2018.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/24/2018] [Accepted: 09/28/2018] [Indexed: 01/02/2023]
Abstract
Chlordecone is an organochlorine used in the 1970's as a pesticide in banana plantations. It has a long half-life in the soil and can potentially contaminate humans and animals through food. Chlordecone targets, and mainly accumulates in, the liver, leading to hepatomegaly and neurological signs in mammals. Chlordecone does not cause liver injuries or any inflammation by itself at low doses, but it can potentiate the hepatotoxic effects of other chemicals and drugs. We studied the impact of chlordecone on the progression of acute hepatitis in mouse models of co-exposure to chlordecone with Concanavalin A or murine hepatitis virus type 3. We examined the progression of these two types of hepatitis by measuring hepatic transaminase levels in the serum and inflammatory cells in the liver, liver histological studies. Amplified tremors presented in the MHV3- chlordecone mouse model had led us to study the expression of specific genes in the brain. We show that chlordecone amplifies the auto-immune hepatitis induced by Concanavalin A by increasing the number of liver NKT cells, which are involved in liver damage. Chlordecone also accelerated the death of mice infected by murine hepatitis virus and enhanced the entry of the virus into the cervical spinal cord in infected mice, leading to considerable neurological damage. In conclusion, chlordecone potentiates both the Concanavalin A-induced hepatitis and brain damage caused by an hepatotropic/neurotropic virus.
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Affiliation(s)
- Elise Tabet
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F 35000, Rennes, France
| | - Moana Gelu-Simeon
- Univ Antilles, CHU Pointe-à-Pitre, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-97000, Pointe-à-Pitre, France
| | - Valentine Genet
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F 35000, Rennes, France
| | - Lucie Lamontagne
- Département des Sciences Biologiques, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Claire Piquet-Pellorce
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F 35000, Rennes, France
| | - Michel Samson
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F 35000, Rennes, France.
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12
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Gelu-Simeon M, Mathurin P. Liver Transplantation for Severe Alcoholic Hepatitis: Where Are We Now? Liver Transpl 2018; 24:1327-1328. [PMID: 30218596 DOI: 10.1002/lt.25337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Moana Gelu-Simeon
- Centre Hospitalier Universitaire Guadeloupe, Université des Antilles, Service d'Hépato-Gastroentérologie, Pointe-à-Pitre, Guadeloupe.,INSERM, Unités Mixtes de Recherche en Santé1085/IRSET, Rennes, France
| | - Philippe Mathurin
- Service des Maladies de l'Appareil Digestif, Hôpital Huriez, CHRU Lille, Université Lille 2, INSERM U795, Lille, France
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13
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Gelu-Simeon M, Chuong AP, Saliba F, Thiery G, Laurent M, Vilain C, Borel M, Amaral L, Alexis M, Saint-Georges G, Saillard E. Submucosal hematoma: a new distinctive sign during emergency upper digestive endoscopy for ammonia ingestion. BMC Gastroenterol 2018; 18:92. [PMID: 29925326 PMCID: PMC6011402 DOI: 10.1186/s12876-018-0809-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 05/29/2018] [Indexed: 01/21/2023] Open
Abstract
Background Submucosal hematoma has never been associated with caustic injuries. Long-term follow-up of patients who ingested ammonia is not well known and ammonia ingestion is rare. Methods In a Single-center observational study, prospective data were collected from 2009 to 2013, in patients over the age of 14 years old referred for ammonia ingestion. The emergency and follow-up endoscopic data and the outcome were reported. Results Ammonia ingestion occurred in 43 patients. Submucosal hematoma of the gastric wall was a distinctive endoscopic sign observed in 15 (34.8%) cases. Oropharyngeal lesions were present in 30 (69.8%) patients, which was associated with ingestion with suicidal intent in 18 cases. Mild and severe endoscopic lesions (grade IIB to IIIB) were found in 16 (37.2%) cases with 10 (23.3%) cases presenting submucosal hematoma at initial endoscopy. A complete spontaneous gastric healing was frequently observed in 36 (83.7%) cases. In 11 cases with submucosal hematoma, a favourable outcome was observed with a medical treatment, however 6 of these patients had severe endoscopic lesions initially. Conclusions Submucosal hematoma of the gastric wall is an endoscopic sign occurring frequently in ammonia ingestion. Submucosal hematoma should be distinguished from necrosis in order to avoid false misclassification in favour of more severe lesions, which would lead to an abusive surgery. Electronic supplementary material The online version of this article (10.1186/s12876-018-0809-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moana Gelu-Simeon
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France. .,INSERM, UMR-S 1085/IRSET, F-35043, Rennes, France. .,Université Antilles-Guyane, Faculté de médecine Hyacinthe Bastaraud, F-97110, Pointe-à-Pitre Cedex, France.
| | - Anh-Phuc Chuong
- CHU de Saint-Pierre, Service d'Hépato-Gastro-Entérologie, F-97448, Saint-Pierre Cedex, La Réunion, France
| | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, F-94800, Villejuif, France
| | - Guillaume Thiery
- CHU de Pointe-à-Pitre, Service de Réanimation, F-97139, Pointe-à-Pitre, Guadeloupe, France
| | - Marc Laurent
- CHU de Saint-Denis, Service d'Hépato-Gastro-Entérologie, F-97405, Saint-Denis, La Réunion, France
| | - Claire Vilain
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France
| | - Marius Borel
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France
| | - Leonardo Amaral
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France
| | - Marceline Alexis
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France
| | - Georgette Saint-Georges
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France
| | - Eric Saillard
- CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Route de Chauvel, F-97159, Pointe-à-Pitre cedex, Guadeloupe, France
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Lewin M, Gelu-Simeon M, Ostos M, Boufassa F, Sobesky R, Teicher E, Meyer L, Fontaine H, Salmon-Céron D, Samuel D, Seror O, Trinchet JC, Duclos-Vallée JC. Imaging Features and Prognosis of Hepatocellular Carcinoma in Patients with Cirrhosis Who Are Coinfected with Human Immunodeficiency Virus and Hepatitis C Virus. Radiology 2015; 277:443-53. [DOI: 10.1148/radiol.2015141500] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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15
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Gelu-Simeon M, Bayan T, Ostos M, Boufassa F, Teicher E, Steyaert JM, Bertucci I, Anty R, Pageaux GP, Meyer L, Duclos-Vallée JC. MELD Score Kinetics in Decompensated HIV+/HCV+ Patients: A Useful Prognostic Tool (ANRS HC EP 25 PRETHEVIC Cohort Study). Medicine (Baltimore) 2015; 94:e1239. [PMID: 26222860 PMCID: PMC4554127 DOI: 10.1097/md.0000000000001239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
To assess prognostic factors for survival and describe Model for End-Stage liver disease (MELD) dynamics in human immunodeficiency virus+/hepatitis C virus+ (HIV+/HCV+) patients after an initial episode of hepatic decompensation.An HIV+/HCV+ cohort of patients experiencing an initial decompensation episode within the year preceding enrollment were followed prospectively. Clinical and biological data were collected every 3 months. Predictors for survival were identified using Kaplan-Meier curves and Cox models. A 2-slope-mixed linear model was used to estimate MELD score changes as a function of survival.Sixty seven patients were included in 32 centers between 2009 and 2012 (72% male; median age: 48 years [interquartile ratio (IQR):45-52], median follow-up: 22.4 months [range: 0.5-65.3]). Overall survival rates were 86%, 78%, and 59% at 6, 12, and 24 months, respectively. Under multivariate analysis, the MELD score at initial decompensation was predictive of survival, adjusted for age, type of decompensation, baseline CD4 counts, and further decompensation during follow-up as a time-dependent variable. The adjusted hazard ratio of death was 1.32 for a score 3 points higher (95% CI: [1.06-1.63], P = 0.012). MELD score kinetics within the 6 months after initial decompensation differed significantly between non-deceased and deceased patients, with a decreased (-0.49/month; P = 0.016), versus a flat (+0.06/month, P = 0.753) mean change in score.MELD is an effective tool to predict survival in HIV+/HCV+ patients with decompensated cirrhosis. A non-decreasing MELD score within 6 months following this initial decompensation episode may benefit from privileged access to liver transplantation in this poor prognosis population.
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Affiliation(s)
- Moana Gelu-Simeon
- From the AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire (MG-S, MO, ET, J-CD-V); DHU Hepatinov, Villejuif (MG-S, MO, ET, J-CD-V); Inserm, UMR 1018 CESP, Centre de Recherche en Epidémiologie et Santé des Populations (TB, FB, LM); Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre (TB, FB, LM, J-CD-V); École Polytechnique, Laboratoire d'Informatique (LIX), Palaiseau (J-MS); ANRS, Agence Nationale de Recherches sur le Sida et les hépatites virales, Paris (IB); Inserm, UMR 1193, Villejuif (J-CD-V); AP-HP Hôpital de Bicêtre, Service de Médecine Interne, Immunologie Clinique et Maladies Infectieuses, Le Kremlin-Bicêtre (ET); Centre Hospitalier Universitaire de Nice - Hôpital de l'Archet, Service d'Hépato-gastroentérologie, Nice (RA); Université de Nice-Sophia-Antipolis, Faculté de Médecine (RA); Inserm, Unité 1065, Nice (RA); Centre Hospitalier Régional Universitaire de Montpellier - Hôpital Saint-Eloi, Service d'Hépato-Gastroentérologie et Transplantation (G-PP); Université Montpellier 1, Faculté de Médecine, Montpellier (G-PP); CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Pointe-à-Pitre Cedex, Guadeloupe (MG-S); Institut National de la Santé et de la Recherche Médicale (Inserm), U.1085, Institut de Recherche Santé Environnement and Travail (IRSET), Rennes (MG-S); and AP-HP Hôpital Bicêtre, Service de Santé Publique, Le Kremlin-Bicêtre, France (LM)
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Zabulon A, Gelu-Simeon M, Bélia L, Chingan V, Duflo S, Vélayoudom-Céphise FL. Maladie de Basedow et anomalies hépatiques : les antithyroïdiens de synthèse ne sont pas les seuls responsables ! Presse Med 2015; 44:110-2. [DOI: 10.1016/j.lpm.2014.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/25/2014] [Accepted: 06/03/2014] [Indexed: 11/27/2022] Open
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Gelu-Simeon M, Lewin M, Sobesky R, Ostos M, Bayan T, Boufassa F, Meyer L, Persoz A, Teicher E, Fontaine H, Salmon-Céron D, Seror O, Trinchet JC, Duclos-Vallée JC. Carcinovic cohort: prognostic factors of death in HIV/HCV coinfected patients with hepatocellular carcinoma (HCC). BMC Infect Dis 2014. [PMCID: PMC4220859 DOI: 10.1186/1471-2334-14-s2-o15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Gelu-Simeon M, Pillas V, Deloumeaux J, Delacroix-Maillard H, Saint-Georges G, Do Amaral L, Borel M, Laurent M, Gordien E, Saillard E. Seroepidemiology of chronic hepatitis B and C in the French Caribbean Island of Guadeloupe. BMC Res Notes 2014; 7:55. [PMID: 24447457 PMCID: PMC3909148 DOI: 10.1186/1756-0500-7-55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 01/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of chronic hepatitis B and C was evaluated some twenty years ago among specific populations in Guadeloupe. The present study was designed to update these data and determine epidemiological features of chronic hepatitis B and C infections in the French Caribbean island of Guadeloupe. FINDINGS The present study was carried out at the Sainte Genevieve Health and Prevention Center (Guadeloupe), between May 2006 and July 2007. This is a medical center where patients can attend a free medical check-up paid for by the Social Security system. Data on hepatitis B (HBV) and C (HCV) status and epidemiological factors were collected for this study.A total of 2,200 patients were included in the study. The prevalence of HBV surface antigen was 1.41% (95% CI: 1.0-2.0), and 0.55% (95% CI: 0.28-0.96) for HCV. The vaccination rate against HBV was 42.0%. HBV transmission was associated with piercing (12.9%, p = 0.014) and familial exposure (6.4%, p < 0.001) and HCV transmission with gynecological surgery (50.0%, p = 0.01). The HBV profile was generally hepatitis B e antigen-negative (94.5%). No hepatitis delta was found. For HCV, genotype 1 was predominant (80%). CONCLUSIONS This is the first study on the prevalence of HBV and HCV among a general clinic based population in Guadeloupe and the Caribbean islands. This study reveals that Guadeloupe is an area of low endemicity for HBV and low HCV prevalence. The reasons for these low prevalence rates are mainly related to the vaccination campaigns carried out during the past twenty years for HBV and the decrease of nosocomial transmission for HCV.
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Affiliation(s)
- Moana Gelu-Simeon
- Department of Hepatology and Gastroenterology, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe.
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Affiliation(s)
- Moana Gelu-Simeon
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 94800, Villejuif, France.
| | - Didier Samuel
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 94800, Villejuif, France. .,INSERM, U785, 94800, Villejuif, France. .,Faculté de Médecine, Université Paris-Sud, 94270, Le Kremlin-Bicêtre, France.
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Gelu-Simeon M, Burlaud A, Young J, Pelletier G, Buffet C. Evolution and predictive factors of thyroid disorder due to interferon alpha in the treatment of hepatitis C. World J Gastroenterol 2009; 15:328-33. [PMID: 19140232 PMCID: PMC2653320 DOI: 10.3748/wjg.15.328] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study predictive factors of thyroid dysfunction associated with interferon-alpha (IFNα) therapy in chronic hepatitis C (CHC) and to describe its long-term evolution in a large population without previous thyroid dysfunction.
METHODS: We performed a follow-up of thyroid function and detection of thyroid antibodies in 301 patients treated for CHC with IFNα from 1999 to 2004.
RESULTS: Thyroid disorder developed in 30/301 (10%) patients with a mean delay of 6 ± 3.75 mo: 13 patients had hyperthyroidism, 11 had hypothyroidism, and 6 had biphasic evolution. During a mean follow-up of 41.59 ± 15.39 mo, 9 patients with hyperthyroidism, 3 with hypothyroidism, and 4 with biphasic evolution normalized thyroid function in 7.88 ± 5.46 mo. Recovery rate of dysthyroidism was not modified by treatment discontinuation, but was better for patients with negative thyroid antibodies before antiviral treatment (P = 0.02). Women had significantly more dysthyroidism (P = 0.05). Positive thyroid peroxidase and thyroglobulin antibodies were more frequent before antiviral treatment in patients who developed dysthyroidism (P < 0.0003 and P = 0.0003, respectively). In a multivariate model, low fibrosis was found to be a predictive factor of dysthyroidism (P = 0.039).
CONCLUSION: In this monocentric population of CHC, dysthyroidism, especially hyperthyroidism, developed in 10% of patients. Low fibrosis was found to be a predictive factor of dysthyroidism. Thyroid disorder recovered in 16/30 patients (53%) and recovery was better in the non-autoimmune form.
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Lambotte O, Gelu-Simeon M, Maigne G, Kotb R, Buffet C, Delfraissy JF, Goujard C. Pegylated interferon alpha-2a-associated life-threatening Evans' syndrome in a patient with chronic hepatitis C. J Infect 2004; 51:e113-5. [PMID: 16230187 DOI: 10.1016/j.jinf.2004.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2004] [Accepted: 10/18/2004] [Indexed: 12/28/2022]
Abstract
In this report, we describe an unusual and unreported complication with the new licensed form of pegylated interferon alpha2a (PEG-IFN-alpha2a). We report the first case of severe autoimmune cytopenias, an Evans' syndrome, in a patient with chronic hepatitis C, 2 months after PEG-IFN-alpha2a initiation. Haemolytic anaemia and thrombocytopenia developed, complicated by gastric bleeding and brain haemorrhage. Outcome was favourable under immunosuppressive treatment. Treatment with PEG-IFN-alpha2a requires careful follow-up, as IFNalpha can induce or exacerbate autoimmune diseases.
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Affiliation(s)
- Olivier Lambotte
- Department of Internal Medicine, Kremlin Bicêtre Hospital, AP-HP, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France.
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