The effects of sustained virological response to direct‐acting anti‐viral therapy on the risk of extrahepatic manifestations of hepatitis C infection

Abstract

Background: Direct-acting anti-viral (DAA) therapy may have a beneficial role in extrahepatic manifestations of hepatitis C virus (HCV) infection. However, the available data are limited. Aim: To examine the effects of DAA treatment on the risk of several extrahepatic manifestations of HCV. Methods: We conducted a retrospective cohort study of patients from the US Department of Veterans Affairs Corporate Data Warehouse who had a positive HCV RNA test and received first course of DAAs between 2012 and 2016. We calculated incidence rates by sustained virological response (SVR) status for six extrahepatic manifestations, and effect of SVR on these conditions was evaluated in adjusted Cox regression models. Results: Of the 45 260 patients treated with DAA with mean follow-up of 2.01 years, 41 711 (92.2%) experienced SVR. Incidence rates ranged from 0.17/ 1000 PY for porphyria cutanea tarda to 21.04/1000 PY for diabetes in the SVR group and 0.51/1000 PY for porphyria cutanea tarda to 23.11/1000 PY for diabetes in the no SVR group. The risk was reduced with SVR for mixed cryoglobulinaemia (adjusted HR (aHR) = 0.23; 95% CI 0.10-0.56), glomerulonephritis (aHR = 0.61; 95% CI 0.41-0.90) and lichen planus (aHR = 0.46; 95% CI 0.30-0.70), but not for non-Hodgkin's lymphoma (aHR = 0.86; 95% CI 0.52-1.43) or diabetes (aHR = 0.98; 95% CI 0.81-1.19). Non significant risk reduction was seen for porphyria cutanea tarda (aHR = 0.33; 95% CI 0.11-1.03). Conclusions: Successful DAA treatment resulting in SVR was associated with significant reductions in the risk of mixed cryoglobulinaemia, glomerulonephritis, lichen planus and possibly porphyria cutanea tarda, but not non-Hodgkin's lymphoma or diabetes. Additional supporting information will be found online in the Supporting Information section at the end of the article. How to cite this article: El-Serag HB, Christie IC, Puenpatom A, Castillo D, Kanwal F, Kramer JR. The effects of sustained virological response to direct-acting anti-viral therapy on the risk of extrahepatic manifestations of hepatitis C infection.

Unmet needs of chronic hepatitis C in the era of direct-acting antiviral therapy

“…56 A retrospective cohort study has shown that the risk of non-Hodgkin lymphoma was not significantly reduced after DAA-induced SVR (hazard ratio, 0.86; 95% confidence interval, 0.52-1.43) after only 2.01 years of follow-up. 56 HCV eradication may reduce the risk of vascular events. 57 However, this was not always the case.…”

Systematic review: chronic viral hepatitis and metabolic derangement

“…Well‐controlled concomitant diseases by pharmacologic treatment are important, not only for diseases control but also for improving outcomes of associated diseases. For CHC patients with NAFLD, clearance of HCV offers benefits on reducing hepatic and extrahepatic events . A previous study showed that steatosis is a negative predictor of SVR following interferon treatment .…”

Treatment of refractory oral lichen planus using direct antiviral agents in a patient with chronic hepatitis C: A case report

“…Moreover, SVR achievement was associated with reduced insulin resistance at follow‐up and a protective effect on the incidence of diabetes 37 . El‐Serag et al reported that successful DAA treatment resulting in SVR was associated with significant reductions in the future risk of conditions, including mixed cryoglobulinemia, glomerulonephritis, and lichen planus 39 …”