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      Use of Liver Imaging and Biopsy in Clinical Practice.

      1 , 1

      The New England journal of medicine

      Massachusetts Medical Society

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          Sofosbuvir and Velpatasvir for HCV in Patients with Decompensated Cirrhosis.

          As the population that is infected with the hepatitis C virus (HCV) ages, the number of patients with decompensated cirrhosis is expected to increase.
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            Intraobserver and Interobserver Variations in Liver Biopsy Interpretation in Patients with Chronic Hepatitis C

             P Bedossa (1994)
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              Sustained virologic response and clinical outcomes in patients with chronic hepatitis C and advanced fibrosis.

              Clinical outcomes of chronic hepatitis C infection in patients with advanced fibrosis include liver failure, hepatocellular carcinoma, and death. To investigate whether sustained virologic response to treatment for hepatitis C is associated with improved clinical outcomes. Retrospective cohort study. 5 hepatology units of tertiary care centers in Europe and Canada caring for patients with chronic hepatitis C treated between 1990 and 2003. Consecutively treated patients with chronic hepatitis C who had biopsy-proven advanced fibrosis or cirrhosis (Ishak score, 4 to 6). Sustained virologic response, defined as absence of detectable hepatitis C virus RNA at 24 weeks after the end of treatment, and clinical outcomes, defined as death (liver-related or non-liver-related), liver failure, and hepatocellular carcinoma. Of 479 patients, 29.6% had sustained virologic response and 70.3% did not. Median follow-up was 2.1 years (interquartile range, 0.8 to 4.9 years). Four patients with and 83 without sustained virologic response had at least 1 outcome event. Sustained virologic response was associated with a statistically significant reduction in the hazard of events (adjusted hazard ratio, 0.21 [95% CI, 0.07 to 0.58]; P = 0.003). The effect was largely attributable to a reduction in liver failure, which developed in no patients with and 42 patients without sustained virologic response (5-year occurrence, 0% vs. 13.3% [CI, 8.4% to 18.2%]; unadjusted hazard ratio, 0.03 [CI, 0.00 to 0.91]). Because few events occurred in the sustained virologic response group, the study had limited ability to detect differences between groups in individual outcomes. In addition, the study was retrospective; selection and survival biases may therefore influence estimates of effect. Sustained virologic response to treatment is associated with improved clinical outcomes, mainly prevention of liver failure, in patients with chronic hepatitis C and advanced fibrosis.
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                Author and article information

                Journal
                N. Engl. J. Med.
                The New England journal of medicine
                Massachusetts Medical Society
                1533-4406
                0028-4793
                August 24 2017
                : 377
                : 8
                Affiliations
                [1 ] From the Division of Gastroenterology and Hepatology and the Institute for Healthcare Policy and Innovation, University of Michigan (E.B.T., A.S.-F.L.), and the Veterans Affairs Hospital (E.B.T.) - both in Ann Arbor.
                Article
                10.1056/NEJMra1610570
                28834467

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