Management of the patient with SVR

Terrault, Norah A.; Hassanein, Tarek

doi:10.1016/j.jhep.2016.08.001

Cited by 62 publications

(55 citation statements)

References 79 publications

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“…In summary, Rosotti et al, 1 as well as our own 5,6 and other studies 7 provide evidence that a subgroup of patients develop liver-related complications despite achieving SVR. In the absence of well-established noninvasive markers for risk stratification after HCV-eradication, patients with pre-treatment advanced chronic liver disease must undergo upper GI endoscopy in regular intervals [7][8][9] and ultrasound for hepatocellular carcinoma surveillance every 6 months.…”

supporting

confidence: 57%

“…In the absence of well-established noninvasive markers for risk stratification after HCV-eradication, patients with pre-treatment advanced chronic liver disease must undergo upper GI endoscopy in regular intervals [7][8][9] and ultrasound for hepatocellular carcinoma surveillance every 6 months. 7,8 In order to optimise patient management, future studies should address two major questions:…”

mentioning

confidence: 99%

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Letter: sustained virological response and liver healing – authors' reply

Mandorfer

Schwabl

Peck‐Radosavljevic

et al. 2017

Aliment Pharmacol Ther

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risk score and varices risk score.3 These scores did not show any baseline differences and, after treatment, none of them improved significantly. C-P stage B/C emerged as a risk factor for PHT worsening [OR 30.0, 95% confidence interval (CI) 2-442, P = 0.002], as well as MELD score ≥10 (OR 10.2, 95% CI 1-121, P = 0.037). Given the small sample size, confidence intervals are quite wide. Despite the dramatic change in natural history of HCV-related liver disease after the availability of DAAs, some potential complications should not be forgotten. Hepatocellular carcinoma after treatment is nowadays the issue of major interest, with several papers reporting conflicting results. 4, 5 Although several data indicate enthusiastic PHT improvements, our observations suggest that a worsening could affect a not negligible number of HIV/HCV co-infected subjects, especially with decompensated liver disease and a high MELD score. Thus, endoscopy monitoring should not be dismissed, especially in these high-risk individuals.

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supporting

confidence: 57%

mentioning

confidence: 99%

Letter: sustained virological response and liver healing – authors' reply

Mandorfer

Schwabl

Peck‐Radosavljevic

et al. 2017

Aliment Pharmacol Ther

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“…As members of this birth cohort age, they contribute to an expanding pool of patients who are at high risk of HCC by virtue of advanced age and cirrhosis (20). Furthermore, metabolic comorbidities such as diabetes (21, 22) and obesity (23), which are increasing in prevalence over time, are additive risk factors for HCC in patients with chronic HCV. A recent study using NHANES data confirmed that HCV-infected patients have a higher prevalence of diabetes than non-infected patients (24).…”

Section: Interferon Treatment and Hccmentioning

confidence: 99%

The Impact of Direct-acting Antiviral Therapy for Hepatitis C on Hepatocellular Carcinoma Risk

Ioannou

2018

Curr Hepatology Rep

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Purpose of review Direct-acting antiviral agents (DAAs) eradicate hepatitis C virus (HCV) infection in the majority of patients. We critically evaluated the impact of DAAs on hepatocellular carcinoma (HCC) risk, a major complication of HCV infection. Recent findings Large cohort studies show that patients who achieve sustained virologic response (SVR) with DAAs have a significantly lower risk of developing de novo HCC than patients who fail treatment or remain untreated. Furthermore, reduction in HCC risk is similar whether SVR is achieved with DAAs or interferon (IFN). However, DAA-induced SVR does not eliminate HCC risk entirely. Therefore, patients with pre-existing cirrhosis require ongoing surveillance even after SVR is achieved. Early, descriptive, uncontrolled reports suggested that DAAs may increase the risk of recurrent HCC. While studying HCC recurrence presents major methodologic challenges, larger studies containing appropriate comparison control groups largely refuted these concerns. Summary Recent studies provide evidence that DAA-induced SVR reduces HCC risk.

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“…Achieving SVR in patients with F3-F4 METAVIR fibrosis leads to a lower incidence of cirrhosis-related complications, J Gastrointestin Liver Dis, September 2017 Vol. 26 No 3: 275-281 liver decompensation and hepatocellular carcinoma, as well as decreased liver-related deaths at 10 years [13][14].…”

Section: Introductionmentioning

confidence: 99%

Real-Life Use of 3 Direct-Acting Antiviral Regimen in a Large Cohort of Patients with Genotype-1b HCV Compensated Cirrhosis

Gheorghe

Iacob

Curescu

et al. 2017

JGLD

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Background & Aims: Ombitasvir/Paritaprevir/ritonavir/Dasabuvir (OBV/PTV/r+DSV) is one of the elective direct-acting antivirals (DAAs) recommended by international guidelines and the only one covered by the National Insurance System in Romania until November 2016. Our aim was to present the first prospective Romanian cohort evaluating the effectiveness and safety in clinical practice of this 3DAA combination in patients with HCV genotype-1b Child A liver cirrhosis.Methods: 681 patients received OBV/PTV/r+DSV+RBV for 12 weeks and were assessed clinically and biologically at baseline, week 4, 8, 12 (end of treatment, EOT), and 12 weeks after therapy (sustained viral response, SVR).Results: Per protocol, EOT virological response was 99.8% and SVR12 rate was 99.4%. Adverse events were present in 36.4% of patients. Permanent discontinuation of 3DAA regimen due to side effects was reported in 11 patients (1.6%). In 47.6% (185/389) of patients, Transient Elastography values were >20kPa (defined as clinically significant portal hypertension, CSPH) at baseline. Independent variables associated with CSPH were: baseline cholesterol level (p=0.003), platelet count <120,000/mm³ (p=0.02), MELD score (p=0.01).Liver stiffness measurement has significantly improved between baseline (26.6±12.7kPa) and SVR12 (21.6±11.8kPa) (p<0.0001). The same was true for APRI score (2.66±0.15 at baseline vs 0.85±0.02 at SVR12, p<0.0001) and FIB4 score (5.53±0.28 vs 3.24±0.08, p<0.0001), but not for Lok score (0.57±0.01 vs 0.63±0.01, p<0.0001).Conclusions: We report a high efficacy of the 3DAA regimen in a homogeneous compensated HCV genotype-1b liver cirrhosis population, in a real-life setting. Noninvasive fibrosis scores significantly improved at SVR12.Abbreviations: AE: adverse effect; AFP: alpha feto-protein; CSPH: clinically significant portal hypertension; DAA: direct-acting antiviral; EOT: end of treatment; GT: genotype; HCV: hepatitis C virus; HCC: hepatocellular carcinoma; LSM: liver stiffness measurement; MELD: Model of end stage liver disease; NHIA: National Health Insurance Agency; OBV/PTV/r+DSV: Ombitasvir/Paritaprevir/ritonavir/Dasabuvir; RBV: ribavirin; SAE: serious adverse effect; SVR: sustained viral response; TE: transient elastography.

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Management of the patient with SVR

Cited by 62 publications

References 79 publications

Letter: sustained virological response and liver healing – authors' reply

Letter: sustained virological response and liver healing – authors' reply

The Impact of Direct-acting Antiviral Therapy for Hepatitis C on Hepatocellular Carcinoma Risk

Real-Life Use of 3 Direct-Acting Antiviral Regimen in a Large Cohort of Patients with Genotype-1b HCV Compensated Cirrhosis

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