Direct-Acting Antivirals May Reduce Risk for Variceal Bleeding in Hepatitis C

Hepatitis C virus (HCV) sustained virologic response as a result of treatment with direct-acting antiviral (DAA) therapy is associated with lower risk for variceal bleeding in patients with and without baseline cirrhosis, according to research results presented at the American Association for the Study of Liver Diseases’ The Liver Meeting held November 8 to 12, 2019, in Boston, Massachusetts.

The study included patients with HCV in the Veterans Affairs healthcare system who received DAA between 2013 and 2015. Patients who achieved sustained virologic response, defined as an undetectable HCV viral load ≥12 weeks after treatment, were followed until January 1, 2019, for incidence of esophageal variceal bleeding occurring >90 days after DAA initiation.

The final cohort consisted of 33,582 patients treated with DAA: 89.3% with sustained virologic response and 10.7% without. In total, 549 (1.6%) experienced post-treatment variceal bleeding. Sustained virologic response after DAA was associated with a lower rate of variceal bleeding in all patients compared with those who did not have sustained virologic response (0.46 vs 1.26 per 100-patient years; adjusted hazard ratio [aHR], 0.66; 95% CI, 0.52-0.83). Further, patients treated with DAAs who had pre-treatment cirrhosis also had a higher incidence of variceal bleeding compared with those who did not have pre-treatment cirrhosis (aHR, 0.73 [95% CI, 0.57-0.93] and 0.33 [95% CI, 0.17-0.65], respectively). Among patients who had prior varices, both bleeding and nonbleeding types, attainment of sustained virologic response was associated with a lower, albeit nonstatistically significant, risk for post-DAA variceal bleeding (3.5 vs 4.9 per 100 patient-years for nonbleeding varices history; 12.9 vs 16.4 per 100 patient-years for bleeding varices history).

“This finding adds to a growing literature on the real-world benefits of DAA-induced [sustained virologic response] and emphasizes the importance of early identification and treatment of HVC-infected patients,” investigators concluded.

Reference

Moon A, Green P, Rockey DC, Berry K, Ioannou G. Hepatitis C eradication reduces the risk of variceal bleeding in 33,582 patients treated with direct-acting antivirals. Presented at: American Association for the Study of Liver Diseases: The Liver Meeting; November 8-12, 2019; Boston, MA. Abstract 0149.