In DAA-Treated Chronic HCV, Older Age Associated With Increased Comorbidities

Researchers assessed changes among an aging population of people with chronic hepatitis C virus who are treated with DAAs, including the development of comorbidities and changes in liver disease severity.

As patients with chronic hepatitis C virus (HCV) age and develop more comorbidities, there is a need for continued evaluation of potential drug-drug interactions. This is according to data published in Digestive and Liver Disease. Investigators found, however, no effect on sustained virologic response (SVR).

While the advent of direct-acting antiviral agents (DAAs) has drastically improved the treatment of chronic HCV and allowed all those infected to receive treatment, it is still unclear how the characteristics of those receiving treatment are changing. Investigators therefore retrospectively analyzed all 2565 chronic HCV patients who received DAAs in a large referral center in Italy from January 2015 to June 2019. Demographic, clinical and virologic characteristics at baseline, as well as the SVR rates according to the year of treatment, were stratified.

Patients were primarily men (52.5%), although the yearly proportion of men and patients with cirrhosis decreased (P <.001) throughout the study period; conversely, mean age increased from 59.8 to 62.2 years (P =.04). Investigators also observed an increasing trend in foreign-born patients, from 4.3% to 7.9%, however, this was not statistically significant. The prevalence of comorbidities increased significantly over the study period (P <.001). The yearly number of experienced patients (P <.001) along with the mean Model for End-Stage Liver Disease (MELD) score of cirrhotic patients decreasing significantly, from 9 to 7.6 (P <.001). SVR rates did increase significantly, from 93.4% in 2015 to 97.1% in 2018 (P <.05).

In terms of limitations, this study was performed at a single center and therefore only reflects the local epidemiology. However, investigators noted that their center in the Lombardia region of Italy is “characterized by a high intra-national migration rate.” A second limitation is the use of a web platform that only collects patient data information on the presence of another chronic liver disease apart from chronic HCV, obesity, diabetes, or hemoglobinopathy, meaning the study is unable to depict a more detailed picture of comorbidities. Finally, investigators noted that they could not report SVR rates from 2019, so it was not possible to ascertain changes in SVR for that year.

Investigators did conclude that, at least in this area, the population of CHC patients receiving DAAs is becoming older and experiencing more comorbidities but milder liver disease. For them, this highlights the importance and need to evaluate drug-drug interactions when treating patients in the future.

“This highlights the importance and need to evaluate the drug-drug interactions when treating future patients,” the researchers concluded. “[T]he percentage of those with advanced liver disease is reducing, supporting the idea of off-loading the management of patients with [chronic HCV] from specialist care to the general practitioner.


Lombardi A, Colaneri M, Vijayagopal KA, et al. Patients with chronic hepatitis C receiving treatment with direct acting antivirals: How is this population changing? [published online July 27, 2020] Dig Liver Dis. doi: 10.1016/j.dld.2020.07.013