Professor Pierre Nahon, the Hepatology Service of Hospital Jean Verdier, AP-HP and Professor Etienne Audureau the Public Health Service of the Henri Mondor Hospital, AP-HP with the University Paris 13, the Inserm and Sorbonne Paris Cité, reported the results of a prospective observational study within the cohort ANRS CO12 CirVir. The latter describes the evolution of patients with compensated cirrhosis due to infection by the virus of hepatitis C, enrolled in liver cancer screening programs or hepatocellular carcinoma (HCC) treated with interferon before 2014 direct antivirals ( DSA) since. The findings, published in the journal Gastroenterology in November 2018, show that if the liver cancer risk is greatly reduced after viral eradication in these patients, it still persists and justified to keep patients with viral cirrhosis C cured in screening programs. This study also confirms the benefits of virologic cure the risk of hepatic carcinogenesis regardless of the type of antiviral treatment.
The direct antiviral (DSA) directed against hepatitis C virus (HCV) have revolutionized the treatment of infected patients since they are made available in 2014 in France. Ensuring virological cure in nearly 100% of patients today at the cost of few side effects, their long-term benefit is still unknown. liver cancer risk or hepatocellular carcinoma (HCC) is the most feared complication in these patients when HCV-induced cirrhosis. Old data obtained before the era of AVD when based on very restrictive interferon treatments allowed to cure that less than 50% of patients have suggested a decreased risk of HCC in case of viral eradication.
The cohort ANRS CO12 CirVir is the oldest prospective cohort of patients infected with the hepatitis B and C supported by the ANRS  . Between March 2006 and December 2012, 1353 patients with cirrhosis, uncomplicated and histologically proven originating infection with the hepatitis C virus were enrolled in 39 French centers. All these patients were enrolled in HCC screening programs as recommended, with conducting a liver ultrasound every 6 months. Patients were followed until December 2016, which allows the analysis with a median decline of more than 5 years.
The researchers were able to analyze the incidence of HCC in the two eras successive therapy (interferon and DSA). The analyzes confirm that if the liver cancer risk is greatly reduced after viral eradication regardless of the type of treatment (it is divided by a factor of about 4), it nevertheless persists and justifies maintaining in screening programs patients with viral cirrhosis C cured. Data from the CirVir cohort reported in this study were also allowed to provide answers about the risk of liver cancer in AVD. The latter is indeed not increased compared to interferon era when a number of confounding factors are taken into account in the analyzes.
The cohort ANRS CO12 CirVir, by its prospective longitudinal nature, has in recent years to study the factors associated with the occurrence of major clinical events in patients with cirrhosis. Nearly twenty works based on data collected prospectively in all Hepatology Services of the territory of 10 years have been published in international journals, covering fields as wide as hepatocellular carcinoma, bacterial infections, extrahepatic cancers and cardiovascular diseases.
(1) The cohort ANRS CO12 CirVir multicenter prospective cohort of patients with viral cirrhosis B and / or C uncomplicated, was initiated in 2006 and included 1822 patients. Patient follow-up was completed in 2017 and a large part of them have now been included in the cohort ANRS CO22 HEPATHER .
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Incidence of Hepatocellular Carcinoma After Direct Antiviral Therapy for HCV in Patients With Cirrhosis Included in Surveillance Programs
Short title: Liver cancer and DAAs
Pierre Nahon, Richard Layese, Valérie Bourcier, Carole Cagnot, Patrick Marcellin, Dominique Guyader, Stanislas Pol, Dominique Larrey, Victor De Lédinghen, Denis Ouzan, Fabien Zoulim, Dominique Roulot, Albert Tran, Jean-Pierre Bronowicki, Jean-Pierre Zarski, Ghassan Riachi, Paul Calès, Jean-Marie Péron, Laurent Alric, Marc Bourlière, Philippe Mathurin, Jean-Frédéric Blanc, Armand Abergel, Lawrence Serfaty, Ariane Mallat, Jean-Didier Grangé, Pierre Attali, Yannick Bacq, Claire Wartelle, Thông Dao, Dominique Thabut, Christophe Pilette, Christine Silvain, Christos Christidis, Eric Nguyen-Khac, Brigitte Bernard- Chabert, David Zucman, Vincent Di Martino, Angela Sutton, Françoise Roudot-Thoraval, Etienne Audureau for the ANRS CO12 CirVir group.