Patients with hepatitis C virus (HCV) infection should receive direct-acting antiviral (DAA) therapy even if they have alcohol use disorder, diabetes, cirrhosis, or hepatic encephalopathy (HE) because HCV eradication reduces the risk for HE, according to a retrospective study published in Clinical Gastroenterology and Hepatology.
HCV is curable in the majority of patients after a short course of DAA therapy, and thus can prevent long-term risk for progressive disease and cirrhosis complications, such as HE. However, it is unclear whether a sustained virologic response (SVR) to DAA therapy reduces the risk for incident HE in patients with HCV infection, or whether it leads to resolution of preexistent HE. Thus, researchers aimed to determine the associations between HCV eradication and the development of incident HE or the resolution of preexistent HE, and to investigate factors such as disease severity and comorbidities that modify these associations.
They found that compared with no SVR, SVR after DAA therapy was associated with a significantly lower risk of developing HE. This association persisted among patients with comorbid alcohol use disorder and diabetes, as well as patients with cirrhosis and model for end-stage liver disease (MELD) scores of 9 or more. SVR was also associated with a reduced risk for hospitalization with HE. However, for patients receiving treatment for HE at the time of antiviral treatment, SVR was associated with a significantly increased likelihood of HE resolution for those with MELD scores below 9, but not those with scores of 9 or more.
The authors concluded that, “In a retrospective study of veterans, we found DAA eradication of HCV infection to be associated with a 59% reduction in risk of development of HE and an increased likelihood of resolution of pre-existing HE in all subgroups except patients with MELD scores of 9 or more.”
Disclosure: Elliot B. Tapper declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of his disclosures.
Tapper EB, Parikh ND, Green PK, et al. Reduced incidence of hepatic encephalopathy and higher odds of resolution associated with eradication of HCV infection [published online October 4, 2019]. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2019.09.033