openRecompensation of chronic hepatitis C-related decompensated cirrhosis following direct-acting antiviral therapy: Prospective cohort study from a hepatitis C virus elimination programMadhumitaPremkumarauthorRadha KDhimanauthorAjayDusejaauthorRohitMehtaniauthorSunilTanejaauthorEktaGuptaauthorPankajGuptaauthorAnchalSandhuauthorPrernaSharmaauthorSahajRathiauthorNipunVermaauthorAnand VKulkarniauthorHarishBhujadeauthorSreedhara BChaluvashettyauthorNaveenKalraauthorGagandeep SGroverauthorJasvinderNainauthorK RajenderReddyauthorBACKGROUND & AIMS: Chronic hepatitis C-related decompensated cirrhosis is associated with lower sustained virologic response (SVR)-12 rates and variable regression of disease severity after direct-acting antiviral agents. We assessed rates of SVR-12, recompensation (Baveno VII criteria), and survival in such patients. METHODS: Between July 2018 and July 2023, patients with decompensated chronic hepatitis C-related cirrhosis after direct-acting antiviral agents treatment were evaluated for SVR-12 and then had 6-monthly follow-up. RESULTS: Of 6516 patients with cirrhosis, 1152 with decompensated cirrhosis (age 53.2 ± 11.5 years; 63% men; Model for End-stage Liver Disease-Sodium MELD-Na: 16.5 $\pm$ 4.6; 87\% genotype 3) were enrolled. SVR-12 was 81.8\% after 1 course; ultimately SVR was 90.8\% after additional treatment. Decompensation events included ascites (1098; 95.3\%), hepatic encephalopathy (191; 16.6\%), and variceal bleeding (284; 24.7\%). Ascites resolved in 86\% (diuretic withdrawal achieved in 24\% patients). Recompensation occurred in 284 (24.7\%) at a median time of 16.5 (interquartile range, 14.5-20.5) months. On multivariable Cox proportional hazards analysis, low bilirubin (adjusted hazard ratio aHR, 0.6; 95\% confidence interval CI, 0.5-0.8; P < 0.001), international normalized ratio (aHR, 0.2; 95\% CI, 0.1-0.3; P < 0.001), absence of large esophageal varices (aHR, 0.4; 95\% CI, 0.2-0.9; P = 0.048), or gastric varices (aHR, 0.5; 95\% CI, 0.3-0.7; P = 0.022) predicted recompensation. Portal hypertension progressed in 158 (13.7\%) patients, with rebleed in 4\%. Prior decompensation with variceal bleeding (aHR, 1.6; 95\% CI, 1.2-2.8; P = 0.042), and presence of large varices (aHR, 2.9; 95\% CI, 1.3-6.5; P < 0.001) were associated with portal hypertension progression. Further decompensation was seen in 221 (19\%); 145 patients died and 6 underwent liver transplantation. A decrease in MELDNa of $\geq$3 was seen in 409 (35.5\%) and a final MELDNa score of <10 was seen in 335 (29\%), but 2.9\% developed hepatocellular carcinoma despite SVR-12. CONCLUSIONS: SVR-12 in hepatitis C virus-related decompensated cirrhosis in a predominant genotype 3 population led to recompensation in 24.7\% of patients over a follow-up of 4 years in a public health setting. Despite SVR-12, new hepatic decompensation evolved in 19\% and hepatocellular carcinoma developed in 2.9\% of patients. (ClinicalTrials.gov, Number: NCT03488485).QR Microbiology2024-12-07Elsevier BVArticle

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