Direct-acting antiviral sustained virologic response: Impact on mortality in patients without advanced liver disease
Direct-acting antiviral sustained virologic response: Impact on mortality in patients without advanced liver disease
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DOI：
10.1002/hep.29811
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发表时间：
2018-09-01
期刊：
影响因子：
13.5
通讯作者：
Mole, Larry A.
中科院分区：
文献类型：
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作者：
Backus, Lisa I.;Belperio, Pamela S.;Mole, Larry A.
对于没有晚期肝病的患者，持续病毒学应答（SVR）对直接作用抗病毒（DAA）治疗后死亡率的影响尚无充分记录，并且影响了治疗的可及性。本研究评估了无干扰素 DAA 治疗实现的 SVR 对无晚期肝病的丙型肝炎病毒感染患者全因死亡率的影响。这项观察性队列分析由退伍军人事务部丙型肝炎临床病例登记处确定的 103,346 名基因型 1、2 和 3 的丙型肝炎病毒单感染患者组成，这些患者没有晚期肝病（根据 FIB-4 3.25 定义，没有诊断为肝硬化、肝代偿失调或肝细胞癌或有肝移植史）。在 40,664 名接受无干扰素 DAA 方案治疗的患者中，39,374 名（96.8%）患者实现 SVR，1,290 名（3.2%）患者未获得 SVR； 62,682 名患者构成了未经治疗的队列。 SVR 患者的死亡率为 1.18 例死亡/100 患者年，显着低于无 SVR 患者（2.84 例死亡/100 患者年；P < 0.001）和未经治疗的患者（3.84 例死亡/100 患者年；P < 0.001）。患有 FIB-4 的 SVR 患者
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