Hepatitis C Treatment With Direct-Acting Antivirals Confers Survival Benefit
New direct-acting antiretroviral agents may have a significant effect on survival.
Among patients with hepatitis C, direct-acting antiviral regimens paritaprevir/ritonavir, ombitasvir, and dasabuvir (PrOD) and ledipasvir/sofosbuvir (LDV/SOF) were shown to be associated with a significant improvement in survival, according to the results of a study published in Clinical Infectious Diseases.
In this case-control study using the Electronically Retrieved Cohort of Hepatitis C Virus Infected Veterans (ERCHIVES), patients with hepatitis C initiated on PrOD (n=1473) or LDV/SOF (n=5497) were matched with control patients who were not started on treatment (n=6970). Exclusion criteria included HIV infection, hepatitis B surface antigen positivity, hepatocellular carcinoma, or missing hepatitis C RNA or Fibrosis-4 scores.
Mortality was higher in untreated people (2.5%) compared with those who received PrOD (0.3%; P <.001) or LDV/SOF (1.4%; P <.001). Moreover, survival at 18 months was higher in treated patients compared with those who were untreated.
In the subgroup analyses stratified by cirrhosis or excluding patients with stage 3 to 5 chronic kidney disease and a diagnosis of drug abuse or dependence, treatment with either regimen was still associated with a significant 18-month survival benefit.
Treatment with either PrOD or LDV/SOF (hazard ratio, 0.43; 95% CI, 0.33-0.57) and achieving sustained virologic response (hazard ratio, 0.57; 95% CI, 0.33-0.99) were significantly associated with reduced mortality.
The study authors concluded that "treatment for HCV with either PrOD or LDV/ SOF and attainment of [sustained virological response] are associated with a significant reduction in mortality, a benefit that is seen within the first 18 months of treatment. Benefits of treatment at a population level are expected to be substantial."
Butt AA, Yan P, Simon TG, Abou-Samra AB. Effect of paritaprevir/ritonavir/ombitasvir/dasabuvir and ledipasvir/sofosbuvir regimens on survival compared with untreated hepatitis C virus-infected persons: results from ERCHIVES. Clin Infect Dis. 2017;65(6):1006-1011.