Hepatitis C Treatment With Direct-Acting Antivirals Confers Survival Benefit

pills spilling out of bottle
pills spilling out of bottle
Primary endpoints are to achieve sustained virologic response, improve survival rates, and lower complications of HCV.

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 ERCHIVESClin Infect Dis. 2017;65(6):1006-1011.