Clinical Outcomes in Patients with HCV after Direct‐Acting Antiviral Treatment: A Prospective Cohort Study, Latin American Liver Research Educational and Awareness Network (LALREAN)

RIDRUEJO E; RAUL ADROVER, NORA C. FERNANDEZ, VALERIA INES DESCALZI, MARCELA SIXTO, ANDRÉS BRUNO, CLAUDIO ESTEPO, ALINA ZEREGA, SILVINA BORZI, NATALIA RATUSNU, ARIEL BILLORDO, DANIEL COCOZZELLA AND MARCELO O. SILVA; MANUEL MENDIZABAL, FEDERICO PIÑERO, HUGO CHEINQUER, MARGARITA ANDERS, BEATRIZ AMEIGEIRAS, VIRGINIA REGGIARDO, ANA PALAZZO, MARIA VIDELA ZUAIN, MARIA ISABEL SCHINONI, CRISTINA ‐ ALONSO, FEDERICO TANNO; SEBASTIAN FIGUEROA, LUISA SANTOS, GUSTAVO ROMERO, DANIELA PEREZ, ALEJANDRO SOZA, MIRTA PERALTA, CECILIA VISTARINI, NELIA HERNANDEZ,

Boston

Congreso; The Liver Meeting; 2019

American Association for the Study of Liver Diseases

Introduction The impact of sustained virological response (SVR) on mortality and newly developing liver-related complications after HCV treatment with direct-acting antivirals (DAAs) is not well documented. This study evaluated the association between SVR on all-cause mortality and liver decompensation events in patients included in the Latin American Liver Research Educational and Awareness Network (LALREAN) registry.Methods A prospective multicenter study including patients who started DDAs from Argentina, Brazil, Chile, Colombia and Uruguay was conducted from January 2016 to May 2019. Patients with history of decompensated cirrhosis were excluded. Primary outcome analysis was a composite end-point including all-cause mortality, new liver decompensation events (ascites, variceal bleeding and/or hepatic encephalopathy), hepatocellular carcinoma (HCC) and need of liver transplantation (LT) according to the intention-to-treat principle. Factors associated with the primary end-point were evaluated conducting a logistic regression multivariable analysis. Cox regression multivariable analysis was performed to evaluate the association between SVR and primary outcomes.Results: From a 2,167 treated patients, 313 with prior liver decompensation were excluded (14.4%) and 1,856 patients were included for the analysis. During a median follow-up of 22.5 months (IQR 12.7-32.4), cumulative incidence of primary composite end-point was 4.2% (CI 3.4;5.2): 16 patients died (0.9%), 66 developed liver events (3.6%) and 41 de novo HCC (2.2%) and 8 underwent LT (0.4%). Patients with advanced fibrosis (F3-4, n=1161) had higher risk of combined end-point when compared with those with mild fibrosis (n=693) HR 2.26 (CI 1.22;4.21, P=0.01) (Fig). In F3-4 patients, HIV coinfection OR 3.13 (CI 1.5;6.6), clinically significant portal hypertension OR 2.29 (CI 1.2;4.3) and albumin