Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar;67(3):553-561.
doi: 10.1136/gutjnl-2017-313983. Epub 2017 Jun 20.

The effect of sustained virological response on the risk of extrahepatic manifestations of hepatitis C virus infection

Parag Mahale  1   2   3 , Eric A Engels  1 , Ruosha Li  4 , Harrys A Torres  5 , Lu-Yu Hwang  2 , Eric L Brown  2 , Jennifer R Kramer  2   3   6
Affiliations

The effect of sustained virological response on the risk of extrahepatic manifestations of hepatitis C virus infection

Parag Mahale et al. Gut. 2018 Mar.

Abstract

Background and aim: Chronic HCV infection is associated with several extrahepatic manifestations (EHMs). Data on the effect of sustained virological response (SVR) on the risk of EHMs are limited.

Methods: We conducted a retrospective cohort study using data of patients from the US Veterans Affairs HCV Clinical Case Registry who had a positive HCV RNA test (10/1999-08/2009). Patients receiving interferon-based antiviral therapy (AVT) were identified. SVR was defined as negative HCV RNA at least 12 weeks after end of AVT. Risks of eight incident EHMs were evaluated in Cox regression models.

Results: Of the 160 875 HCV-infected veterans, 31 143 (19.4%) received AVT, of whom 10 575 (33.9%) experienced SVR. EHM risk was reduced in the SVR group compared with untreated patients for mixed cryoglobulinaemia (adjusted HR (aHR)=0.61; 95% CI 0.39 to 0.94), glomerulonephritis (aHR=0.62; 95% CI 0.48 to 0.79), porphyria cutanea tarda (PCT) (aHR=0.41; 95% CI 0.20 to 0.83), non-Hodgkin's lymphoma (NHL) (aHR=0.64; 95% CI 0.43 to 0.95), diabetes (aHR=0.82; 95% CI 0.76 to 0.88) and stroke (aHR=0.84; 95% CI 0.74 to 0.94), but not for lichen planus (aHR=1.11; 95% CI 0.78 to 1.56) or coronary heart disease (aHR=1.12; 95% CI 0.81 to 1.56). Risk reductions were also observed when patients with SVR were compared with treated patients without SVR for mixed cryoglobulinaemia, glomerulonephritis, PCT and diabetes. Significant reductions in the magnitude of aHRs towards the null with increasing time to initiation of AVT after HCV diagnosis were observed for glomerulonephritis, NHL and stroke.

Conclusions: Risks of several EHMs of HCV infection are reduced after AVT with SVR. However, early initiation of AVT may be required to reduce the risk of glomerulonephritis, NHL and stroke.

Keywords: Hepatitis C virus; antiviral therapy; extrahepatic manifestations; sustained virological response.

PubMed Disclaimer

Conflict of interest statement

Competing interests: HAT is a consultant for Gilead Sciences, Janssen Pharmaceuticals, Merck and Co., Dynavax Technologies, Vertex Pharmaceuticals, and Genentech, and has received research grants from Gilead Sciences, Merck and Co., and Vertex Pharmaceuticals. Other authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:
Flow chart to determine the selection of patients in the study cohort
Figure 2:
Figure 2:
The risk of extrahepatic manifestations in HCV-infected veterans according to time to initiation of antiviral therapy The figure depicts the adjusted hazard ratios and the corresponding 95% confidence intervals (Y-axes) that represent the risk of extrahepatic manifestations in HCV-infected veterans. Comparisons were conducted between individuals who received antiviral therapy with SVR and those who were untreated. The time to initiation of antiviral therapy from HCV-index date is represented on the X-axes. Abbreviations: aHR, adjusted hazard ratios; AVT, antiviral therapy; CI, confidence intervals; HCV, hepatitis C virus; SVR, sustained virological response
See this image and copyright information in PMC

Comment in

References

    1. Mohd Hanafiah K, Groeger J, Flaxman AD, et al. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology 2013;57:1333–42. - PubMed
    1. El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology 2012;142:1264–73.e1. - PMC - PubMed
    1. Spiegel BM, Younossi ZM, Hays RD, et al. Impact of hepatitis C on health related quality of life: a systematic review and quantitative assessment. Hepatology 2005;41:790–800. - PubMed
    1. Negro F, Forton D, Craxi A, et al. Extrahepatic Morbidity and Mortality of Chronic Hepatitis C. Gastroenterology 2015;149:1345–60. - PubMed
    1. Ferri C, Ramos-Casals M, Zignego AL, et al. International diagnostic guidelines for patients with HCV-related extrahepatic manifestations. A multidisciplinary expert statement. Autoimmun Rev 2016;15:1145–60. - PubMed

Publication types

MeSH terms