CirVir Cohort

The aim of the ANRS CO12 CirVir study is to describe the natural history of a large cohort of patients with viral cirrhosis.

Last updated on 27 July 2026

In brief

Between 2006 and 2017, the ANRS CO12 CirVir cohort monitored more than 1,800 patients with viral cirrhosis caused by hepatitis B and/or C.

The aim of CirVir was to identify the factors associated with the occurrence of the main clinical complications, to assess the level of risk for these complications, and thereby to tailor patient management according to the level of risk for each complication.

The data collected have also enabled the development of a database and their integration into various international research programmes.

The ANRS CO12 CirVir cohort involves the prospective follow–up of nearly 1,800 patients with viral cirrhosis enrolled at 35 centres across France and followed since 2006.

The aim of the CirVir cohort

Whilst several cohorts have sought to describe the clinical course of patients with hepatitis B and/or C, very few have investigated the long-term outcomes of these patients once liver disease has progressed to cirrhosis or the incidence of hepatocellular carcinoma. The ANRS CO12 CirVir cohort is designed to address this objective.

The aim of the ANRS CO12 CirVir study is to describe the natural history of a large cohort of patients with uncomplicated viral cirrhosis followed prospectively, to identify the factors associated with the occurrence of the main clinical complications, and to identify and validate predictive scores for assessing the level of risk of these complications.

Inclusion criteria and follow-up

Between March 2006 and June 2017, 1,822 patients were enrolled across the 35 participating centres.

All patients have uncomplicated, histologically confirmed cirrhosis caused by at least one of the following: hepatitis B and/or C virus infection. They are followed up prospectively, in accordance with widely established guidelines, in terms of specialist consultations, liver imaging (ultrasound, MRI, CT) and laboratory tests every 6 months.

In addition, biological samples will be collected at enrolment and every 12 months to establish a serum bank, a plasma bank and a DNA bank (concentrate of nucleated cells).

Expertise in the management and utilisation of biobanks

The analysis of data from the ANRS CO12 CirVir cohort within the Clinical Research Unit (URC) at Henri-Mondor Hospital has enabled the development of a shared database with other French and European cohorts, whether or not they originate from ANRS MIE programmes (the ANRS CO22 Hepather cohort, the ANRS LICAVIR project, the APHP CIRRAL cohort, and the APHP CHC 2000 trial), which now brings together more than 5,000 patients with long-term longitudinal follow-up. “This pooling of data provides a unique tool for studying the complications of cirrhosis, and in particular hepatocellular carcinoma, by enabling large-scale analyses and the identification of robust prognostic biomarkers,” states the project team.

The work carried out by the CirVir cohort has enabled the project team to develop genuine expertise in the management and utilisation of sequential biobanks linked to longitudinal clinical data, notably thanks to the support of ANRS MIE through dedicated funding (the CITHEC and STHEPBIO-virus projects).

This expertise has led to the CirVir cohort being integrated into several high-profile, industry-relevant flagship projects, including the BPI HECAM project in 2018, the DELIVER RHU in 2022, the European GENIAL project in 2023, and the LIVERTRACK RHU in 2024.

Improving care for at-risk patients

The results of this study should enable the adaptation of patient care according to the level of risk for each complication: screening for and treatment of lesions caused by portal hypertension, early screening for and treatment of hepatocellular carcinoma (HCC), chemoprevention of HCC, indications for liver transplantation, etc.

More than 30 publications, including several articles in leading international journals such as Journal of Hepatology, Hepatology, Gut and Gastroenterology, have been produced based on the findings of the CirVir cohort. “This research has made a significant contribution to improving our understanding of the natural history of viral cirrhosis, its complications and the associated prognostic factors,” states the project team.

Nahon P, Layese R, Natella PA, Parlati L, Saidi T, Ganne-Carrie N, N’Kontchou G, Chaffaut C, Nault JC, Bamba-Funck J, Sutton A, Nzinga CL, Carrat F, Audureau E, Anrs Co12 CirVir ACOH, groups C. Comparative evaluation of regression and machine-learning models for hepatocellular carcinoma risk stratification across diverse aetiologies. JHEP Rep. 2026;8(4):101740.

Roulot D, Layese R, Brichler S, Ganne N, Asselah T, Zoulim F, Gordien E, Nahon P, Roudot-Thoraval F, DeltaVir, CirVir study g. Hepatitis D Virus Infection Markedly Increases the Risk of Hepatocellular Carcinoma in Patients With Viral B Cirrhosis. Clin Gastroenterol Hepatol. 2025;23(11):1943-53 e2.

Nahon P, Lusivika-Nzinga C, Merle P, Zoulim F, Decaens T, Ganne-Carrie N, Pageaux GP, Leroy V, Alric L, Bronowicki JP, Bourliere M, Gournay J, Tran A, Pol S, Mathurin P, Loustaud-Ratti V, Metivier S, De Ledinghen V, Abergel A, Thabut D, D’Alteroche L, Bouattour M, Asselah T, Ouzan D, Cales P, Chazouilleres O, Gelu-Simeon M, Roulot D, Boursier J, Cagnot C, Tamazirt S, Pascale A, Nilusmas S, Lewin M, Ziol M, Carrat F, Duclos-Vallee JC, Anrs Co12 CirVir COH, groups L. Value of non-invasive test dynamics in guiding HCC surveillance decisions after HCV cure in patients with cirrhosis. J Hepatol. 2025;83(3):701-11.

Nahon P, Layese R, Ganne-Carrie N, Moins C, N’Kontchou G, Chaffaut C, Ronot M, Audureau E, Durand-Zaleski I, Natella PA, CirVir AC, groups C. The clinical and financial burden of nonhepatocellular carcinoma focal lesions detected during the surveillance of patients with cirrhosis. Hepatology. 2024;79(4):813-28.

Nahon P, Bamba-Funck J, Layese R, Trepo E, Zucman-Rossi J, Cagnot C, Ganne-Carrie N, Chaffaut C, Guyot E, Ziol M, Sutton A, Audureau E, CirVir AC, groups C. Integrating genetic variants into clinical models for hepatocellular carcinoma risk stratification in cirrhosis. J Hepatol. 2023;78(3):584-95.

Moreau C, Roux M, Riou J, Canivet CM, Audureau E, Lusivika-Nzinga C, Nahon P, Carrat F, Boursier J, group ACC, the ACOHg. Dynamic personalized prediction of the individual liver-related risk after sustained viral response in HCV patients. J Viral Hepat. 2023;30(6):567-77.

Ollivier-Hourmand I, Repesse Y, Nahon P, Chaffaut C, Dao T, Nguyen TTN, Marcellin P, Roulot D, De Ledinghen V, Pol S, Guyader D, Archambeaud I, Zoulim F, Oberti F, Tran A, Bronowicki JP, D’Alteroche L, Ouzan D, Peron JM, Zarski JP, Bourliere M, Larrey D, Louvet A, Cales P, Abergel A, Mathurin P, Mallat A, Blanc JF, Nguyen-Khac E, Riachi G, Alric L, Serfaty L, Antonini T, Moreno C, Attali P, Thabut D, Pilette C, Grange JD, Silvain C, Carbonell N, Bernard-Chabert B, Goria O, Wartelle C, Moirand R, Christidis C, Perlemuter G, Ozenne V, Henrion J, Hillaire S, Di Martino V, Amiot X, Sutton A, Barget N, Chevret S, Ganne-Carrie N, Anrs Co12 Cirvir Cg. ABO blood group does not influence Child-Pugh A cirrhosis outcome: An observational study from CIRRAL and ANRS CO12 CIRVIR cohorts. Liver Int. 2022;42(6):1386-400.

Nahon P, Najean M, Layese R, Zarca K, Segar LB, Cagnot C, Ganne-Carrie N, N’Kontchou G, Pol S, Chaffaut C, Carrat F, Ronot M, Audureau E, Durand-Zaleski I, CirVir AC, Hepather AC, Scientific Committee – Voting m, groups C. Early hepatocellular carcinoma detection using magnetic resonance imaging is cost-effective in high-risk patients with cirrhosis. JHEP Rep. 2022;4(1):100390.

Nahon P, Layese R, Cagnot C, Asselah T, Guyader D, Pol S, Pageaux GP, De Ledinghen V, Ouzan D, Zoulim F, Audureau E, group ACC. HCV Eradication in Primary or Secondary Prevention Optimizes Hepatocellular Carcinoma Curative Management. Cancer Prev Res (Phila). 2021;14(5):581-92.

Ganne-Carrie N, Nahon P, Chaffaut C, N’Kontchou G, Layese R, Audureau E, Chevret S, group C, group ACC. Impact of cirrhosis aetiology on incidence and prognosis of hepatocellular carcinoma diagnosed during surveillance. JHEP Rep. 2021;3(3):100285.

Elkrief L, Lazareth M, Chevret S, Paradis V, Magaz M, Blaise L, Rubbia-Brandt L, Moga L, Durand F, Payance A, Plessier A, Chaffaut C, Valla D, Malphettes M, Diaz A, Nault JC, Nahon P, Audureau E, Ratziu V, Castera L, Garcia Pagan JC, Ganne-Carrie N, Rautou PE, Group ACC. Liver Stiffness by Transient Elastography to Detect Porto-Sinusoidal Vascular Liver Disease With Portal Hypertension. Hepatology. 2021;74(1):364-78.

Zarski JP, David-Tchouda S, Trocme C, Margier J, Vilotitch A, Hilleret MN, Cagnot C, Boursier V, Ziol M, Sutton A, Layese R, Audureau E, Roudot-Thoraval F, Nahon P. Non-invasive fibrosis tests to predict complications in compensated post-hepatitis C cirrhosis. Clin Res Hepatol Gastroenterol. 2020;44(4):524-31.

Audureau E, Carrat F, Layese R, Cagnot C, Asselah T, Guyader D, Larrey D, De Ledinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Cales P, Peron JM, Alric L, Bourliere M, Mathurin P, Blanc JF, Abergel A, Chazouilleres O, Mallat A, Grange JD, Attali P, d’Alteroche L, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Pol S, Nahon P, group ACC. Personalized surveillance for hepatocellular carcinoma in cirrhosis – using machine learning adapted to HCV status. J Hepatol. 2020;73(6):1434-45.

Thabut D, Bureau C, Layese R, Bourcier V, Hammouche M, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Ledinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Goria O, Cales P, Peron JM, Alric L, Bourliere M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grange JD, Attali P, Bacq Y, Wartelle-Bladou C, Dao T, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Hillaire S, Di Martino V, Sutton A, Audureau E, Roudot-Thoraval F, Nahon P, group ACC. Validation of Baveno VI Criteria for Screening and Surveillance of Esophageal Varices in Patients With Compensated Cirrhosis and a Sustained Response to Antiviral Therapy. Gastroenterology. 2019;156(4):997-1009 e5.

Salmon-Ceron D, Nahon P, Layese R, Bourcier V, Sogni P, Bani-Sadr F, Audureau E, Merchadou L, Dabis F, Wittkop L, Roudot-Thoraval F, CirVir AC, groups ACHs. Human Immunodeficiency Virus/Hepatitis C Virus (HCV) Co-infected Patients With Cirrhosis Are No Longer at Higher Risk for Hepatocellular Carcinoma or End-Stage Liver Disease as Compared to HCV Mono-infected Patients. Hepatology. 2019;70(3):939-54.

Gelu-Simeon M, Lewin M, Ostos M, Bayan T, Beso Delgado M, Teicher E, Layese R, Roudot-Thoraval F, Fontaine H, Sobesky R, Salmon-Ceron D, Samuel D, Seror O, Nahon P, Meyer L, Duclos-Vallee JC, Anrs Hc Ep 25 Prethevic ACOH, Groups ACCS. Prognostic factors of survival in HIV/HCV co-infected patients with hepatocellular carcinoma: The CARCINOVIC Cohort. Liver Int. 2019;39(1):136-46.

Costentin CE, Layese R, Roudot-Thoraval F, Audureau E, Nahon P, group ACC. Reply. Gastroenterology. 2019;156(1):289-90.

Brichler S, Nahon P, Zoulim F, Layese R, Bourcier V, Audureau E, Sutton A, Letouze E, Cagnot C, Marcellin P, Guyader D, Roulot D, Pol S, de Ledinghen V, Zarski JP, Cales P, Tran A, Peron JM, Mallat A, Riachi G, Grange JD, Blanc JF, Bacq Y, Ouzan D, Bronowicki JP, Mathurin P, Larrey D, Alric L, Attali P, Serfaty L, Pilette C, Bourliere M, Thabut D, Silvain C, Wartelle C, Zucman D, Christidis C, Roudot-Thoraval F, Ganne-Carrie N, group ACCs. Non-virological factors are drivers of hepatocellular carcinoma in virosuppressed hepatitis B cirrhosis: Results of ANRS CO12 CirVir cohort. J Viral Hepat. 2019;26(3):384-96.

Wendum D, Layese R, Ganne-Carrie N, Bourcier V, Merabtene F, Cagnot C, Sauce E, Barget N, Bedossa P, Terris B, Selves J, Bioulac-Sage P, Sturm N, Sattonnet C, Nahon P, Roudot-Thoraval F, Ziol M, Group ACC. Influence of Progenitor-Derived Regeneration Markers on Hepatitis C Virus-Related Cirrhosis Outcome (ANRS CO12 CirVir Cohort). Hepatology. 2018;68(4):1534-48.

Nahon P, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Ledinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Cales P, Peron JM, Alric L, Bourliere M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grange JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Roudot-Thoraval F, Audureau E, Group ACC. Incidence of Hepatocellular Carcinoma After Direct Antiviral Therapy for HCV in Patients With Cirrhosis Included in Surveillance Programs. Gastroenterology. 2018;155(5):1436-50 e6.

Costentin CE, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Ledinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Cales P, Peron JM, Alric L, Bourliere M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grange JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Letouze E, Imbeaud S, Zucman-Rossi J, Audureau E, Roudot-Thoraval F, Nahon P, Group ACC. Compliance With Hepatocellular Carcinoma Surveillance Guidelines Associated With Increased Lead-Time Adjusted Survival of Patients With Compensated Viral Cirrhosis: A Multi-Center Cohort Study. Gastroenterology. 2018;155(2):431-42 e10.

Cacoub P, Nahon P, Layese R, Blaise L, Desbois AC, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Ledinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Cales P, Peron JM, Alric L, Bourliere M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grange JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Capron D, Thiefin G, Zucman D, Di Martino V, Bagnis CI, Ziol M, Sutton A, Letouze E, Roudot-Thoraval F, Audureau E, group ACC. Prognostic value of viral eradication for major adverse cardiovascular events in hepatitis C cirrhotic patients. Am Heart J. 2018;198:4-17.

Buscail C, Bourcier V, Fezeu LK, Roulot D, Brule S, Ben-Abdesselam Z, Cagnot C, Hercberg S, Nahon P, Ganne-Carrie N, Julia C. Eating Patterns in Patients with Compensated Cirrhosis: A Case-Control Study. Nutrients. 2018;10(1).

Bastard JP, Fellahi S, Audureau E, Layese R, Roudot-Thoraval F, Cagnot C, Mahuas-Bourcier V, Sutton A, Ziol M, Capeau J, Nahon P, group ACC. Elevated adiponectin and sTNFRII serum levels can predict progression to hepatocellular carcinoma in patients with compensated HCV1 cirrhosis. Eur Cytokine Netw. 2018;29(3):112-20.

Allaire M, Nahon P, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Ledinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Cales P, Peron JM, Alric L, Bourliere M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grange JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, V DIM, Sutton A, Letouze E, Audureau E, Roudot-Thoraval F, Group ACC. Extrahepatic cancers are the leading cause of death in patients achieving hepatitis B virus control or hepatitis C virus eradication. Hepatology. 2018;68(4):1245-59.

Nahon P, Lescat M, Layese R, Bourcier V, Talmat N, Allam S, Marcellin P, Guyader D, Pol S, Larrey D, De Ledinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Goria O, Cales P, Peron JM, Alric L, Bourliere M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grange JD, Attali P, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Hillaire S, Di Martino V, Trinchet JC, Moreau R, Roudot-Thoraval F, CirVir AC, Microcir G. Bacterial infection in compensated viral cirrhosis impairs 5-year survival (ANRS CO12 CirVir prospective cohort). Gut. 2017;66(2):330-41.

Nahon P, Bourcier V, Layese R, Audureau E, Cagnot C, Marcellin P, Guyader D, Fontaine H, Larrey D, De Ledinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Leroy V, Riachi G, Cales P, Peron JM, Alric L, Bourliere M, Mathurin P, Dharancy S, Blanc JF, Abergel A, Serfaty L, Mallat A, Grange JD, Attali P, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Zucman D, Di Martino V, Thibaut V, Salmon D, Ziol M, Sutton A, Pol S, Roudot-Thoraval F, Group ACC. Eradication of Hepatitis C Virus Infection in Patients With Cirrhosis Reduces Risk of Liver and Non-Liver Complications. Gastroenterology. 2017;152(1):142-56 e2.

Cadier B, Bulsei J, Nahon P, Seror O, Laurent A, Rosa I, Layese R, Costentin C, Cagnot C, Durand-Zaleski I, Chevreul K, CirVir AC, groups C. Early detection and curative treatment of hepatocellular carcinoma: A cost-effectiveness analysis in France and in the United States. Hepatology. 2017;65(4):1237-48.

Ganne-Carrie N, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, de Ledinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Cales P, Peron JM, Alric L, Bourliere M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grange JD, Attali P, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Zucman D, Di Martino V, Trinchet JC, Nahon P, Roudot-Thoraval F, Group ACCS. Nomogram for individualized prediction of hepatocellular carcinoma occurrence in hepatitis C virus cirrhosis (ANRS CO12 CirVir). Hepatology. 2016;64(4):1136-47.

Carrat F, Nahon P, Duclos-Vallee JC, Pageaux GP, Fontaine H, Pol S, carcinoma Acsgoh. Reply to « A strong message is needed to address the issue of HCC recurrence after DAA therapy ». J Hepatol. 2016;65(6):1269-70.

Trinchet JC, Bourcier V, Chaffaut C, Ait Ahmed M, Allam S, Marcellin P, Guyader D, Pol S, Larrey D, De Ledinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Goria O, Cales P, Peron JM, Alric L, Bourliere M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grange JD, Buffet C, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Thiefin G, Hillaire S, Di Martino V, Nahon P, Chevret S, Group ACC. Complications and competing risks of death in compensated viral cirrhosis (ANRS CO12 CirVir prospective cohort). Hepatology. 2015;62(3):737-50.