Lower risk of hep C extrahepatic manifestations with sustained virological response

Last Updated: 2017-06-28

By Will Boggs MD

NEW YORK (Reuters Health) - Patients who achieved a sustained virological response (SVR) to interferon-based antiviral therapy for hepatitis C virus (HCV) had a reduced risk of extrahepatic manifestations, according to a retrospective cohort study.

�€œHealth care providers of HCV-infected individuals should educate patients as to the extrahepatic benefits of treating the infection, in addition to reduced risk of progression of liver fibrosis and liver cancer,�€ Dr. Parag Mahale from National Cancer Institute, Rockville, Maryland told Reuters Health by email. �€œAs direct-acting antiviral drugs have dramatically increased the cure rates with few side effects and shorter duration of therapy, health care providers should provide HCV treatment as soon as possible after diagnosis to maximize these benefits.�€

Extrahepatic manifestations (EHMs) associated with chronic HCV infection include essential mixed cryoglobulinemia, some subtypes of B cell non-Hodgkin's lymphoma (NHL), membranoproliferative glomerulonephritis, porphyria cutanea tarda (PCT), and lichen planus, as well as type 2 diabetes, coronary heart disease, and stroke.

Dr. Mahale and colleagues used data from the Department of Veteran Affairs HCV Clinical Case Registry to study the effect of SVR after interferon-based antiviral therapy on the risk of these eight EHMs and 160,875 veterans who were followed for a median 5.1 years.

Most EHMs were rare (<1 per 1000 person-years), and their incidence was lower in the treated groups when compared with untreated veterans, except for lichen planus, according to the June 20th online report in Gut.

Achievement of SVR was associated with a 39% lower risk of mixed cryoglobulinemia, a 38% lower risk of glomerulonephritis, a 59% lower risk of PCT, a 36% lower risk of NHL, and 18% lower risk of diabetes, and a 16% lower risk of stroke.

There was no reduction in the risk of lichen planus or coronary heart disease in association with SVR.

Later initiation of antiviral therapy was associated with a diminishing reduction in the risk of glomerulonephritis, NHL, and stroke.

�€œAll the extrahepatic manifestations that we studied have risk factors other than HCV infection; we were not able to adjust for these within individual participants in the study,�€ Dr. Mahale said. �€œFor example, diet, obesity, and genetic factors play a major role in increasing the risk of diabetes mellitus. To reduce the risk of diabetes, those factors should be targeted, in addition to treatment of HCV.�€

�€œOur study was conducted among U.S. war veterans, which is a unique cohort with different risk profiles for various outcomes, compared to the general population,�€ he said. �€œTherefore, this study should be replicated in other populations.�€

�€œAlso, we could study only interferon-containing regimens which are no longer the standard of care for HCV-infected people,�€ Dr. Mahale said. �€œHence, we recommend replication of our study in people who received interferon-free direct-acting antiviral therapy.�€

SOURCE: http://bit.ly/2tkxUq8

Gut 2017.