HCV: DAAs slash risk for early death, HCC in ANRS CO22

  • Lancet
  • 11 Feb 2019

  • curated by Yael Waknine
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.


  • HCV treatment with direct-acting antivirals (DAAs) reduces risks for early mortality and hepatocellular carcinoma (HCC), according to data from the large prospective French ANRS CO22 Hepather cohort study.

Why this matters

  • “These findings firmly counter those of a Cochrane review of [DAA] treatment trials that could neither confirm nor reject if [DAAs] had an effect on long-term HCV-related morbidity and mortality,” writes Raymond T. Chung, MD, in an associated comment.
  • Results support universal DAA treatment for HCV.

Study design

  • Longitudinal multicenter study of 9895 HCV-infected patients (74.2% DAA-treated, 25.8% untreated), followed for 33.4 months (interquartile ratio, 24.0-40.7 months).
  • Funding: INSERM-ANRS, ANR, DGS, MSD, Janssen, Gilead, AbbVie, Bristol-Myers Squibb, and Roche.    

Key results

  • 218 patients died, 258 were diagnosed with HCC, and 106 developed decompensated cirrhosis (DC).
  • In unadjusted analysis, DAAs were tied to higher odds of HCC (HR=2.77) and DC (HR=3.83; both P<.0001>
  • In adjusted analysis, DAAs yielded:
    • 52% lower risk for early mortality (aHR=0.48; P=.0001; 40 vs 84 deaths per 10,000 patients), including liver-related (aHR=0.39; P=.0020) and non-liver-related deaths (aHR=0.60; P=.048).
    • 34% lower risk for HCC (aHR=0.66, P=.018; 89 vs 129 cases per 10,000 patients).
    • No effect on DC risk (P=.72).
  • Benefits were consistent among cirrhotic patients (30.8%) with HCV clearance.
  • Analysis adjusted for demographics/geography, BMI, infection route, fibrosis score, prior treatment experience, genotype, alcohol use, diabetes, hypertension, biological variables, and model for end-stage liver disease (MELD) score.


  • Biopsy rarely used to confirm cirrhosis.
  • Potentially underpowered to detect reduced DC.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.