Sustained virological response lowers extrahepatic complications risk in HCV, especially in women

Sustained virological response (SVR) results in a reduction in the risk of extrahepatic complications in patients with hepatitis C virus (HCV) infection, particularly in women, a study has found.

“The significantly increased risk associated with interferon (IFN) tissue factor in women—a subset who represented roughly 10 percent of that group—underscores the importance of prioritizing these patients for direct-acting antiviral (DAA) treatment irrespective of the fibrosis stage,” the authors said.

In this study, the observation started at the date of HCV diagnosis (untreated) or last antiviral treatment start (treated). The authors used an inverse probability-weighting approach to address treatment selection bias. They estimated the effect of treatment on the cumulative incidence of outcomes using the Fine-Gray method. Death was a competing risk.

Of the HCV patients, 40 percent (n=15,295) were women. After controlling for other risk factors, SVR (IFN or DAA) significantly reduced the risk of all outcomes, with the effect being more pronounced among female patients.

Women who achieved SVR after IFN-based treatment had significantly lower risk of acute coronary syndrome (ACS) than men with SVR from either treatment type (subdistribution hazard ratio [sHR], 0.45, 95 percent confidence interval [CI], 0.35–0.59 vs 0.81, 95 percent CI, 0.69–0.96 for DAA SVR and 0.72, 95 percent CI, 0.62–0.85 for IFN SVR).

Successful treatment appeared most protective against end-stage renal disease (ESRD): female patients who achieved SVR had 66–68-percent lower risk than untreated patients (DAA SVR: sHR, 0.32, 95 percent CI, 0.17–0.60; IFN SVR: sHR, 0.34, 95 percent CI, 0.20–0.58), while male patients had 38–42-percent lower risk (DAA SVR: sHR, 0.62, 95 percent CI, 0.46–0.85; IFN SVR: sHR, 0.58, 95 percent CI, 0.43–0.76).

On the other hand, IFN treatment failure led to a significant increase in the risk of all outcomes by 50–100 percent in female patients. Women who experienced IFN treatment failure had 63-percent higher risk of ACS (sHR, 1.63, 95 percent CI, 1.35–1.96), nearly twice the risk of ESRD (sHR, 1.95, 95 percent CI, 1.43–2.66), and 51-percent increased risk of stroke (sHR, 1.49, 95 percent CI, 1.11–2.00) than those who received no treatment.