Successful treatment of hepatitis C virus (HCV) infection and achieving sustained virological response (SVR) may reduce the risk for developing type 2 diabetes (T2D), according to a large cohort study published in the Journal of Viral Hepatitis.
Using data from the longitudinal Chronic Hepatitis Cohort study, a registry drawn from 4 geographically and racially diverse US health systems, researchers investigated the incidence of T2D at 12 weeks post-HCV treatment in 5127 patients infected with HCV without a history of T2D or hepatitis B. The average follow-up period was 3.7 years.
The researchers found that the incidence of T2D was significantly lower in patients who achieved a SVR (231/2748; 6.2%) compared with patients who failed HCV treatment (299/1279; 21.7%).
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.
Recently published data showed a link between sustained virologic response and a reduced risk for hepatocellular carcinoma among patients treated with direct-acting antivirals for hepatitis C.
“Data on HCC risk following DAA induced SVR are still sparse and conflicting,” Fasiha Kanwal, MD, MSHS, from the DeBakey Veterans Affairs Medical Center, Houston, Texas, and colleagues wrote. “We found that, among patients treated with DAA, virological cure of HCV resulted in a considerable reduction in the risk of HCC.However, the absolute risk of HCC was high in several patient groups who achieved cure, including [approximately] 40% of patients who had progressed to cirrhosis.”
To assess the risk and determinants for HCC in patients cured with DAAs, the researchers gathered data on 22,500 patients treated for HCV with DAAs from the Veterans Health Administration system, 19,518 of whom achieved SVR.
A little more than a year after the Netherlands instituted a policy allowing unrestricted access to direct-acting antivirals for the treatment of hepatitis C, researchers have already seen a dramatic decline in acute hepatitis C virus (HCV) infections among one at-risk population, HIV-positive men who have sex with men.
Starting in the early 2000s researchers began to report outbreaks of acute hepatitis C in European cities. Although sexual transmission of HCV is rare overall, it occurs more often among HIV-positive men who have sex with men (MSM).
Novel direct-acting antiviral DAA combination therapies tremendously improved sustained virologic response (SVR) rates in patients with chronic HCV infection. SVR is typically accompanied by normalization of liver enzymes, however, hepatic inflammation, i.e. persistently elevated aminotransferase levels may persist despite HCV eradication. Aim: To investigate prevalence and risk factors for ongoing hepatic inflammation after SVR in two large patient cohorts.
This post-hoc analysis was based on prospectively collected demographic and clinical data from 834 patients with SVR after HCV treatment with either PegIFN- or DAA-based treatment regimens from the PRAMA trial (n = 341) or patients treated at our outpatient clinic (n = 493).
We observed an unexpected high prevalence of post-SVR inflammation, including patients who received novel IFN-free DAA-based therapies. Up to 10% of patients had ongoing elevation of aminotransferase levels and another 25% showed aminotransferase activity above the so-called healthy range. Several baseline factors were independently associated with post-SVR aminotransferase elevation. Among those, particularly male gender, advanced liver disease and markers for liver steatosis were strongly predictive for persistent ALT elevation. The use of IFN-based antiviral treatment was independently correlated with post-SVR inflammation, further supporting the overall benefit of IFN-free combination regimens.
This is the first comprehensive study on a large patient cohort investigating the prevalence and risk factors for ongoing liver inflammation after eradication of HCV. Our data show a high proportion of patients with ongoing hepatic inflammation despite HCV eradication with potential implications for the management of approximately one third of all patients upon SVR.
WEDNESDAY, Jan. 4, 2017 (HealthDay News) — For patients with hepatitis C virus (HCV) infection and biopsy-proven cirrhosis, sustained viral response (SVR) is associated with a reduction in critical events, both liver and non-liver related, according to research published in the January issue of Gastroenterology.
Pierre Nahon, M.D., Ph.D., from the Hôpital Jean Verdier in Bondy, France, and colleagues conducted a retrospective review using data from 1,323 patients in a prospective viral cirrhosis cohort. Patients had HCV infection and biopsy-proven cirrhosis, were Child-Pugh class A, and had no previous liver complications. Patients received anti-HCV treatment before or after inclusion and underwent ultrasound examination every six months, as well as endoscopic assessments.
The researchers found that 50.5 percent of the patients achieved SVR after a median follow-up of 58.2 months. SVR correlated with reduced incidence of hepatocellular carcinoma and hepatic decompensation (hazard ratios, 0.29 and 0.26, respectively). The risks of cardiovascular events and bacterial infections were also lower with SVRs (hazard ratios, 0.42 and 0.44, respectively). In patients with SVRs, but not patients with viremia, metabolic features correlated with higher risk of hepatocellular carcinoma. SVR correlated with a reduction in overall mortality (hazard ratio, 0.27) and death from liver-related and non-liver-related causes.