HCV eradication reduces risk for certain nonliver events

  • El-Serag HB & al.
  • Aliment Pharmacol Ther
  • 01/04/2019

  • Yael Waknine
  • Clinical Essentials
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Takeaway

  • HCV eradication with direct-acting antivirals (DAAs) is tied to significantly reduced risks for mixed cryoglobulinemia, glomerulonephritis, and lichen planus.

Why this matters

  • Limited data exist on extrahepatic benefits of HCV treatment.
  • Risks for non-Hodgkin's lymphoma (NHL), porphyria cutanea tarda (PCT), and diabetes remained unaffected.

Study design

  • Data for 45,260 patients (mean age, 61.77 years) treated with DAAs at Veterans Affairs facilities during 2012-2016 (96.63% men, 53.78% white, 37.27% black).
  • Mean follow-up, 2.01 years.
  • Funding: NIH; National Institute of Diabetes and Digestive and Kidney Disease; Merck & Co., Inc., Kenilworth, NJ, USA.

Key results

  • 92.2% achieved sustained virological response (SVR).
  • Prevalence with SVR vs without, per 1000 person-years:
    • Mixed cryoglobulinemia: 0.22 vs 0.9 (P=.0013),
    • Glomerulonephritis: 2.21 vs 3.8 (P=.0055),
    • PCT: 0.17 vs 0.51 (P=.0482),
    • Lichen planus: 1.58 vs 3.37 (P=.0004),
    • NHL: 1.88 vs 2.33 (P=.54), and
    • Diabetes: 21.04 vs 23.11 (P=.53).
  • Multivariate analysis tied SVR to reduced risks (adjusted HRs) for:
    • Mixed cryoglobulinemia: 0.23 (P=.0012),
    • Glomerulonephritis: 0.61 (P=.0126); and
    • Lichen planus: 0.46 (P=.0003).
  • No significant benefit was observed with respect to NHL (P=.57), diabetes (P=.86), or PCT (P=.06).

Limitations

  • Retrospective design.
  • Homogeneous cohort.
  • Limited follow-up.