Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, Palo Alto, CA, USA.
The impact of sustained virologic response (SVR) on mortality after direct-acting antiviral (DAA) treatment is not well documented in patients without advanced liver disease and affects access to treatment. This study evaluated the impact of SVR achieved with interferon-free DAA treatment on all-cause mortality in hepatitis C (HCV) infected patients without advanced liver disease. This observational cohort analysis was comprised of 103,346 genotype 1, 2 and 3, HCV-monoinfected patients without advanced liver disease, defined by FIB-4 ≤3.25 and no diagnosis of cirrhosis, hepatic decompensation, hepatocellular carcinoma or history of liver transplantation, identified from the Veterans Affairs Hepatitis C Clinical Case Registry. Among 40,664 patients treated with interferon-free DAA regimens, 39,374 (96.8%) achieved SVR and 1,290 (3.2%) patients were No SVR; 62,682 patients constituted the untreated cohort. The mortality rate for SVR patients of 1.18 deaths/100 patient years was significantly lower than both the rate for No SVR patients (2.84 deaths/100 patient years)(p<0.001) and untreated patients (3.84 deaths/100 patient years)(p<0.001). SVR patients with FIB-4 <1.45 and 1.45-3.25 had a 46.0% (p=0.036) and 63.2% (p<0.001) reduction in mortality rates, respectively, compared to No SVR patients and a 66.7% (p<0.001) and 70.6% (p<0.001) reduction in mortality rates, respectively, compared to untreated patients. In multivariate Cox proportional hazard models controlling for baseline demographics, clinical characteristics and comorbidities, SVR was independently associated with reduced risk of death compared to No SVR (hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.32-0.59, p<0.001) and compared to untreated patients (HR 0.32, 95%CI 0.29-0.36, p<0.001).
Successfully treating HCV with DAAs in patients without clinically apparent advanced liver disease translates into a significant mortality benefit.