Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, Palo Alto, CA.
Hepatology. 2018 Sep;68(3):827-838. doi: 10.1002/hep.29811. Epub 2018 May 14.
The impact of sustained virologic response (SVR) on mortality after direct-acting antiviral (DAA) treatment is not well documented in patients without advanced liver disease and affects access to treatment. This study evaluated the impact of SVR achieved with interferon-free DAA treatment on all-cause mortality in hepatitis C virus-infected patients without advanced liver disease. This observational cohort analysis was comprised of 103,346 genotype 1, 2, and 3, hepatitis C virus-monoinfected patients without advanced liver disease, defined by FIB-4 ≤3.25 and no diagnosis of cirrhosis, hepatic decompensation, or hepatocellular carcinoma or history of liver transplantation, identified from the Veterans Affairs Hepatitis C Clinical Case Registry. Among 40,664 patients treated with interferon-free DAA regimens, 39,374 (96.8%) achieved SVR and 1,290 (3.2%) patients were No SVR; 62,682 patients constituted the untreated cohort. The mortality rate for SVR patients of 1.18 deaths/100 patient-years was significantly lower than the rates for both No SVR patients (2.84 deaths/100 patient-years; P < 0.001) and untreated patients (3.84 deaths/100 patient-years; P < 0.001). SVR patients with FIB-4 <1.45 and 1.45-3.25 had a 46.0% (P = 0.036) and 63.2% (P < 0.001) reduction in mortality rates, respectively, compared to No SVR patients and 66.7% (P < 0.001) and 70.6% (P < 0.001) reduction in mortality rates, respectively, compared to untreated patients. In multivariate Cox proportional hazard models controlling for baseline demographics, clinical characteristics, and comorbidities, SVR was independently associated with reduced risk of death compared to No SVR (hazard ratio, 0.44; 95% confidence interval, 0.32-0.59; P < 0.001) and compared to untreated patients (hazard ratio, 0.32; 95% confidence interval, 0.29-0.36; P < 0.001).
Successfully treating hepatitis C virus with DAAs in patients without clinically apparent advanced liver disease translates into a significant mortality benefit. (Hepatology 2018).
未发现进展性肝疾病的丙型肝炎病毒感染者经无干扰素直接作用抗病毒药物（DAA）治疗获得持续病毒学应答（SVR）对死亡率的影响尚未得到充分证实，且该影响与治疗准入相关。本研究评估了无进展性肝疾病的丙型肝炎病毒单感染患者经无干扰素 DAA 治疗获得 SVR 对全因死亡率的影响。本观察性队列分析纳入了来自退伍军人事务部丙型肝炎临床病例登记处的 103346 例基因型 1、2 和 3 丙型肝炎病毒感染者，这些患者无进展性肝疾病，定义为 FIB-4≤3.25，无肝硬化、肝失代偿、肝细胞癌或肝移植诊断史或既往肝移植史。在接受无干扰素 DAA 治疗方案的 40664 例患者中，39374 例（96.8%）获得 SVR，1290 例（3.2%）未获得 SVR；62682 例为未治疗组。SVR 患者的死亡率为 1.18 例/100 患者-年，明显低于未获得 SVR 患者（2.84 例/100 患者-年；P＜0.001）和未治疗患者（3.84 例/100 患者-年；P＜0.001）。与未获得 SVR 患者相比，FIB-4＜1.45 和 1.45-3.25 的 SVR 患者的死亡率分别降低 46.0%（P=0.036）和 63.2%（P＜0.001），与未治疗患者相比，死亡率分别降低 66.7%（P＜0.001）和 70.6%（P＜0.001）。多变量 Cox 比例风险模型校正基线人口统计学、临床特征和合并症后，与未获得 SVR 相比，SVR 与降低死亡风险独立相关（风险比，0.44；95%置信区间，0.32-0.59；P＜0.001），与未治疗患者相比，SVR 与降低死亡风险也独立相关（风险比，0.32；95%置信区间，0.29-0.36；P＜0.001）。
在无明显临床进展性肝疾病的丙型肝炎病毒感染者中成功用 DAA 治疗丙型肝炎病毒可显著降低死亡率。（《肝脏病学》（Hepatology）2018 年）
