Although treating hepatitis C virus (HCV) with direct-acting antivirals (DAA) regimens has demonstrated numerous extrahepatic benefits, a significant benefit can be specifically attributed to a reduction in liver-related mortality, according to results of a study published in the Journal of Hepatology.1
Newer DAA regimens are associated with sustained virologic response rates in 90% to 95% of patients with HCV and are associated with reductions in mortality, liver-related complications, diabetes, and cardiovascular disease events.1-12 However, whether the reduction in overall mortality is due to a reduction in the incidence of other comorbidities or due to a reduction in liver-related deaths remains unknown.
Therefore researchers compared liver-related mortality rates in persons with or without chronic HCV infection and determined the effect of HCV treatment, type of treatment regimen used, and attainment of sustained virologic response upon liver-related mortality in the treated persons.1 Using data from the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES) between January 1, 2002 to December 31, 2016, the study included 50,674 patients with HCV who received treatment (group A) patients, 31,749 patients with HCV who did not receive treatment (group B), and 73,526 people without HCV (group C).
Among these participants, there was an 8.6% mortality rate in group A, 35.0% in group B, and 14.3% in group C. Among those who died, viral hepatitis associated liver-related mortality rates per 100 patients years were: 0.28 for group A, 1.44 for group B, and 0.06 for group C (P <.0001 for both comparisons). Among patients with HCV who received treatment, rates were 0.06 for those with sustained virologic response and 0.78 for those without sustained virologic response. In addition, treatment with DAA regimens and sustained virologic response were associated with reduced hazards of liver-related mortality.
“In conclusion, treatment for HCV is associated with a significant reduction in viral hepatitis associated liver-related mortality which is particularly pronounced in those treated with a DAA regimen and those who attain [sustained virologic response],” stated the study authors.1
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
- Butt AA, Yan P, Shaikh OS, Lo Re V III, Abou-Samra AB, Sherman KE. Treatment of HCV reduces viral hepatitis-associated liver-related mortality in patients: An ERCHIVES study [published online March 4, 2020]. J Hepatol. doi:10.1016/j.jhep.2020.02.022.
- Backus LI, Belperio PS, Shahoumian TA, Loomis TP, Mole LA. Effectiveness of sofosbuvir-based regimens in genotype 1 and 2 hepatitis C virus infection in 4026 U.S. Veterans. Aliment Pharmacol Ther. 2015;42:559-573.
- Butt AA, Yan P, Shaikh OS, Chung RT, Sherman KE. Sofosbuvir-based regimens in clinical practice achieve SVR rates closer to clinical trials: results from ERCHIVES. Liver Int. 2016;36:651-658.
- Backus LI, Boothroyd DB, Phillips BR, Belperio P, Halloran J, Mole LA. A sustained virologic response reduces risk of all-cause mortality in patients with hepatitis C. Clin Gastroenterol Hepatol. 2011;9:509-516.e1.
- Backus LI, Belperio PS, Shahoumian TA, Mole LA. Impact of sustained virologic response with direct-acting antiviral treatment on mortality in patients with advanced liver disease. Hepatology. 2019;69(2):487-497.
- 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;65:1006-1011.
- Carrat F, Fontaine H, Dorival C, et al. Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. Lancet. 2019;393:1453-1464.
- Nahon P, Bourcier V, Layese R, et al. Eradication of hepatitis C virus infection in patients with cirrhosis reduces risk of liver and non-liver complications. Gastroenterology. 2017;152:142-156.e2.
- Butt AA, Ren Y, Marks K, Shaikh OS, Sherman KE. Do directly acting antiviral agents for HCV increase the risk of hepatic decompensation and decline in renal function? Results from ERCHIVES. Aliment Pharmacol Ther. 2017;45:150-159.
- Calvaruso V, Cabibbo G, Cacciola I, et al. Incidence of hepatocellular carcinoma in patients with HCV-associated cirrhosis treated with direct-acting antiviral agents. Gastroenterology 2018;155:411-421.e4.
- Masarone M, Persico M. Hepatitis C virus infection and non-hepatocellular malignancies in the DAA era: A systematic review and meta-analysis. Liver Int. 2019;39(7):1292-1306
- Butt AA, Yan P, Aslam S, Shaikh OS, Abou-Samra AB. Hepatitis C virus treatment with directly acting agents reduces the risk of incident diabetes – Results from ERCHIVES [published online April 12, 2019]. Clin Infect Dis. doi:10.1093/cid/ciz304
- Butt AA, Yan P, Shuaib A, Abou-Samra AB, Shaikh OS, Freiberg MS. Direct-acting antiviral therapy for HCV infection is associated with a reduced risk of cardiovascular disease events. Gastroenterology. 2019;156:987-996.