未经证实:HCV治愈后,并非所有患者都实现显著的肝纤维化消退。我们探讨了临床和社会行为因素对肝纤维化的影响,在使用直接抗病毒药物治疗HCV之前和之后。
未经评估:我们分析了正在进行的ANRSCO22HEPATHER队列的数据,前瞻性收集HCV感染患者的临床和社会行为数据。混合效应逻辑回归模型有助于确定严重肝纤维化纵向测量的预测因子,定义为纤维化-4指数>3.25。我们还估计了调整后的人口归因分数(PAF)的可改变的危险因素。
UNASSIGNED:在9,692名研究患者中(在4年的随访中占24,687次就诊,其中48.5%为HCV治愈后),26%的患者在登记时出现严重纤维化。经过多变量调整后,HCV治愈的患者发生严重纤维化的风险降低了87%。发现咖啡消费的剂量-反应成反比关系,严重纤维化风险每增加一杯/天减少58%(校正比值比(aOR0.42;95%CI0.38-0.46).失业,教育水平低,和糖尿病与更高的严重纤维化风险相关(分别为aOR1.69;95%CI1.32-2.16,aOR1.50;95%CI1.20-1.86和aOR4.27;95%CI3.15-5.77).先前/当前不健康饮酒的个体的严重纤维化风险比戒断患者高3.6/4.6倍。所有这些关联在HCV治愈后仍然有效。造成严重纤维化负担最大的危险因素是失业,教育水平低,和糖尿病(PAFs:29%,21%,17%,分别)。
UNASSIGNED:监测HCV治愈后的肝纤维化对于社会经济地位低的患者至关重要,以前/当前不健康的酒精使用,和糖尿病。需要针对社会上最脆弱的个体的创新HCV护理模式和针对更健康的生活方式的干预措施,以加强HCV治愈对肝脏健康的积极影响。
未经批准:丙型肝炎病毒(HCV)治愈后,并非所有患者都实现显著的肝纤维化消退。在这里,我们研究了临床和社会行为因素对严重肝纤维化风险的影响.咖啡消费与严重纤维化呈强烈负相关,而糖尿病,以前和现在不健康的饮酒与4.3有关,严重纤维化的风险高出3.6倍和4.6倍,分别。失业和低教育水平也与严重纤维化的高风险相关。所有这些关联在HCV治愈后仍然有效。这些结果表明,有必要在高危人群中继续进行肝纤维化监测,并促进丙型肝炎病毒治愈后更健康的生活方式作为临床和公共卫生的优先事项。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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.