Severe liver fibrosis in the HCV cure era: Major effects of social vulnerability, diabetes, and unhealthy behaviors
Background & Aims: After HCV cure, not all patients achieve significant liver fibrosis regression. We explored the effects of clinical and socio-behavioral factors on liver fibrosis, before and after HCV cure with direct-acting antivirals. Methods: We analyzed data from the ongoing ANRS CO22...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | JHEP Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555922000532 |
| _version_ | 1818530084736204800 |
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| author | Patrizia Carrieri Fabrice Carrat Vincent Di Beo Marc Bourlière Tangui Barré Victor De Ledinghen Georges-Philippe Pageaux Morgane Bureau Carole Cagnot Céline Dorival Elisabeth Delarocque-Astagneau Fabienne Marcellin Stanislas Pol Hélène Fontaine Camelia Protopopescu |
| author_facet | Patrizia Carrieri Fabrice Carrat Vincent Di Beo Marc Bourlière Tangui Barré Victor De Ledinghen Georges-Philippe Pageaux Morgane Bureau Carole Cagnot Céline Dorival Elisabeth Delarocque-Astagneau Fabienne Marcellin Stanislas Pol Hélène Fontaine Camelia Protopopescu |
| author_sort | Patrizia Carrieri |
| collection | DOAJ |
| description | Background & Aims: After HCV cure, not all patients achieve significant liver fibrosis regression. We explored the effects of clinical and socio-behavioral factors on liver fibrosis, before and after HCV cure with direct-acting antivirals. Methods: We analyzed data from the ongoing ANRS CO22 HEPATHER cohort, which prospectively collects clinical and socio-behavioral data on HCV-infected patients. Mixed-effects logistic regression models helped identify predictors of longitudinal measures of severe liver fibrosis, defined as a fibrosis-4 index >3.25. We also estimated the adjusted population attributable fractions (PAFs) for modifiable risk factors. Results: Among the 9,692 study patients (accounting for 24,687 visits over 4 years of follow-up, 48.5% of which were post-HCV cure), 26% had severe fibrosis at enrolment. After multivariable adjustment, HCV-cured patients had an 87% lower risk of severe fibrosis. An inverse dose-response relationship was found for coffee consumption, with the risk of severe fibrosis diminishing by 58% per additional cup/day (adjusted odds ratio (aOR 0.42; 95% CI 0.38-0.46). Unemployment, low educational level, and diabetes were associated with a higher severe fibrosis risk (aOR 1.69; 95% CI 1.32-2.16, aOR 1.50; 95% CI 1.20-1.86, and aOR 4.27; 95% CI 3.15-5.77, respectively). Severe fibrosis risk was 3.6/4.6-fold higher in individuals with previous/current unhealthy alcohol use than in abstinent patients. All these associations remained valid after HCV cure. The risk factors accounting for the greatest severe fibrosis burden were unemployment, low education level, and diabetes (PAFs: 29%, 21%, and 17%, respectively). Conclusions: Monitoring liver fibrosis after HCV cure is crucial for patients with low socioeconomic status, previous/current unhealthy alcohol use, and diabetes. Innovative HCV care models for the most socially vulnerable individuals and interventions for healthier lifestyles are needed to reinforce the positive effects of HCV cure on liver health. Lay summary: After hepatitis C virus (HCV) cure, not all patients achieve significant liver fibrosis regression. Herein, we studied the effects of clinical and socio-behavioral factors on the risk of severe liver fibrosis. Coffee consumption was strongly inversely associated with severe fibrosis, while diabetes, previous and current unhealthy alcohol use were associated with a 4.3-, 3.6- and 4.6-fold higher risk of severe fibrosis, respectively. Unemployment and low educational level were also associated with a higher risk of severe fibrosis. All these associations remained valid after HCV cure. These results demonstrate the need to continue liver fibrosis monitoring in at-risk groups, and to facilitate healthier lifestyles after HCV cure as a clinical and public health priority. |
| first_indexed | 2024-12-11T17:15:16Z |
| format | Article |
| id | doaj.art-4b97959e06af4bcaa1731a6df9910b4d |
| institution | Directory Open Access Journal |
| issn | 2589-5559 |
| language | English |
| last_indexed | 2024-12-11T17:15:16Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHEP Reports |
| spelling | doaj.art-4b97959e06af4bcaa1731a6df9910b4d2022-12-22T00:57:21ZengElsevierJHEP Reports2589-55592022-06-0146100481Severe liver fibrosis in the HCV cure era: Major effects of social vulnerability, diabetes, and unhealthy behaviorsPatrizia Carrieri0Fabrice Carrat1Vincent Di Beo2Marc Bourlière3Tangui Barré4Victor De Ledinghen5Georges-Philippe Pageaux6Morgane Bureau7Carole Cagnot8Céline Dorival9Elisabeth Delarocque-Astagneau10Fabienne Marcellin11Stanislas Pol12Hélène Fontaine13Camelia Protopopescu14Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, FranceINSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France; Unité de Santé Publique, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, FranceAix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, FranceAix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France; Hôpital St Joseph, Service d'Hépato-Gastroentérologie, Marseille, FranceAix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, FranceHepatology Unit, University Hospital Bordeaux and INSERM U-1053, Bordeaux University, Pessac, FranceCHU Saint-Eloi, Département d’hépato-gastroentérologie et de transplantation hépatique, Université de Montpellier, Montpellier, FranceAix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, FranceANRS MIE (France Recherche Nord & Sud Sida-HIV Hépatites, Maladies Infectieuses Emergentes), Paris, FranceINSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, FranceUniversité Paris-Saclay, UVSQ, Inserm, CESP, Team Anti-infective Evasion and Pharmacoepidemiology, 78180 Montigny, France; AP-HP, GHU Paris-Saclay University, Raymond Poincaré Hospital, Epidemiology and Public Health Department, 92380 Garches, FranceAix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France; Corresponding author. Address: INSERM UMR 1252 SESSTIM, Aix-Marseille Univ, ISSPAM, Faculté de Médecine, 3e étage –Aile Bleue, 27, boulevard Jean Moulin, 13385 MARSEILLE cedex 5, France.Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Unité d'Hépatologie, Paris, France; Université Paris Descartes, INSERM U-1223, Institut Pasteur, Paris, FranceAssistance Publique - Hôpitaux de Paris, Hôpital Cochin, Unité d'Hépatologie, Paris, France; Université Paris Descartes, INSERM U-1223, Institut Pasteur, Paris, FranceAix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, FranceBackground & Aims: After HCV cure, not all patients achieve significant liver fibrosis regression. We explored the effects of clinical and socio-behavioral factors on liver fibrosis, before and after HCV cure with direct-acting antivirals. Methods: We analyzed data from the ongoing ANRS CO22 HEPATHER cohort, which prospectively collects clinical and socio-behavioral data on HCV-infected patients. Mixed-effects logistic regression models helped identify predictors of longitudinal measures of severe liver fibrosis, defined as a fibrosis-4 index >3.25. We also estimated the adjusted population attributable fractions (PAFs) for modifiable risk factors. Results: Among the 9,692 study patients (accounting for 24,687 visits over 4 years of follow-up, 48.5% of which were post-HCV cure), 26% had severe fibrosis at enrolment. After multivariable adjustment, HCV-cured patients had an 87% lower risk of severe fibrosis. An inverse dose-response relationship was found for coffee consumption, with the risk of severe fibrosis diminishing by 58% per additional cup/day (adjusted odds ratio (aOR 0.42; 95% CI 0.38-0.46). Unemployment, low educational level, and diabetes were associated with a higher severe fibrosis risk (aOR 1.69; 95% CI 1.32-2.16, aOR 1.50; 95% CI 1.20-1.86, and aOR 4.27; 95% CI 3.15-5.77, respectively). Severe fibrosis risk was 3.6/4.6-fold higher in individuals with previous/current unhealthy alcohol use than in abstinent patients. All these associations remained valid after HCV cure. The risk factors accounting for the greatest severe fibrosis burden were unemployment, low education level, and diabetes (PAFs: 29%, 21%, and 17%, respectively). Conclusions: Monitoring liver fibrosis after HCV cure is crucial for patients with low socioeconomic status, previous/current unhealthy alcohol use, and diabetes. Innovative HCV care models for the most socially vulnerable individuals and interventions for healthier lifestyles are needed to reinforce the positive effects of HCV cure on liver health. Lay summary: After hepatitis C virus (HCV) cure, not all patients achieve significant liver fibrosis regression. Herein, we studied the effects of clinical and socio-behavioral factors on the risk of severe liver fibrosis. Coffee consumption was strongly inversely associated with severe fibrosis, while diabetes, previous and current unhealthy alcohol use were associated with a 4.3-, 3.6- and 4.6-fold higher risk of severe fibrosis, respectively. Unemployment and low educational level were also associated with a higher risk of severe fibrosis. All these associations remained valid after HCV cure. These results demonstrate the need to continue liver fibrosis monitoring in at-risk groups, and to facilitate healthier lifestyles after HCV cure as a clinical and public health priority.http://www.sciencedirect.com/science/article/pii/S2589555922000532coffeedirect-acting antiviralsFIB-4hepatitis Calcoholsocial status |
| spellingShingle | Patrizia Carrieri Fabrice Carrat Vincent Di Beo Marc Bourlière Tangui Barré Victor De Ledinghen Georges-Philippe Pageaux Morgane Bureau Carole Cagnot Céline Dorival Elisabeth Delarocque-Astagneau Fabienne Marcellin Stanislas Pol Hélène Fontaine Camelia Protopopescu Severe liver fibrosis in the HCV cure era: Major effects of social vulnerability, diabetes, and unhealthy behaviors JHEP Reports coffee direct-acting antivirals FIB-4 hepatitis C alcohol social status |
| title | Severe liver fibrosis in the HCV cure era: Major effects of social vulnerability, diabetes, and unhealthy behaviors |
| title_full | Severe liver fibrosis in the HCV cure era: Major effects of social vulnerability, diabetes, and unhealthy behaviors |
| title_fullStr | Severe liver fibrosis in the HCV cure era: Major effects of social vulnerability, diabetes, and unhealthy behaviors |
| title_full_unstemmed | Severe liver fibrosis in the HCV cure era: Major effects of social vulnerability, diabetes, and unhealthy behaviors |
| title_short | Severe liver fibrosis in the HCV cure era: Major effects of social vulnerability, diabetes, and unhealthy behaviors |
| title_sort | severe liver fibrosis in the hcv cure era major effects of social vulnerability diabetes and unhealthy behaviors |
| topic | coffee direct-acting antivirals FIB-4 hepatitis C alcohol social status |
| url | http://www.sciencedirect.com/science/article/pii/S2589555922000532 |
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