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Design

• Observational prospective cohort (France)
• 12 502 HCV-infected patients
  • Exclusion criteria: HBV co-infection, history of decompensated cirrhosis, HCC or liver transplant, treatment with IFN-RBV ± 1st generation PI, no follow-up
• Survival time since enrolment or start of DAA (censoring date: July 1st, 2017, or death, or HCC, or decompensated cirrhosis)
• Cox proportional hazards models with Inverse Probability of Treatment Weighting (IPTW) to quantify the impact of DAA (as a time dependent-covariate) on clinical outcomes
  • IPTW scores were obtained from a logistic model linking treatment with baseline covariates that confounded the treatment-outcome relationship

Study population

• 6 460 patients received DAA
  • 8 462 patient-years of follow up, occurrence of 90 deaths, 164 HCC and 77 decompensation
• 2 835 patients did not receive DAA
  • 10 040 patient-years of follow up, occurrence of 78 deaths, 57 HCC and 35 decompensation

Baseline characteristics

• Median (IQR) age: 56 (50-65) years
• Male: 54%
• Cirrhosis: 38%
• Treatment experienced: 54%
• Genotype
  • 1: 66%
  • 2: 7%
  • 3: 11%
  • 4: 12%
• Diabetes: 12%
• BMI = 30 kg/m 2 : 13%
• Hypertension: 29%

Association of baseline characteristics and DAA treatment during follow-up (multivariate analysis)

• More likely to start DAA if
  • Age > 50 years
  • Genotype 3 (vs genotype 1)
  • Fibrosis F3-F4 (vs F0-F1)
• Less likely to start DAA if
  • Female
  • Genotype 2 (vs genotype 1)
  • Treatment naive

All-cause-deaths Weighted survival (IPTW)

Hepatocellular carcinoma Weighted survival (IPTW)

HCC = DAA - : 57 vs DAA + : 164

Decompensated cirrhosis Weighted survival (IPTW)

Decompensation = DAA - : 35 vs DAA + : 77

Conclusions

• DAA was associated with
  • a decreased risk of death
    • The decrease in deaths was more pronounced for liver-related deaths than for non liver-related deaths
  • and no increased risk of HCC and decompensation