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Reuters Health Information: Extrahepatic manifestations of chronic hep C improve with sustained virological response

Extrahepatic manifestations of chronic hep C improve with sustained virological response

Last Updated: 2018-05-18

By Will Boggs MD

NEW YORK (Reuters Health) - Extrahepatic manifestations of chronic hepatitis C virus (HCV) infection improve or resolve after patients achieve sustained virological response (SVR), researchers from France report.

"Antiviral therapy can reduce not only hepatic manifestations of HCV but also many extrahepatic manifestations related to HCV when SVR is achieved," said Dr. Patrice Cacoub from Hopital La Pitie-Salpetriere in Paris.

"Such findings reinforce the importance (of diagnosing and treating) early all HCV infected patients to avoid hepatic and extrahepatic complications," he told Reuters Health by email.

As many as two-thirds of patients with chronic HCV infection develop extrahepatic manifestations, which have been shown to play a role in HCV mortality.

Dr. Cacoub and colleagues undertook a systematic review and meta-analysis of 48 studies to assess the impact of achieving SVR after antiviral treatment on the extrahepatic morbidity and mortality in patients with the disease.

Achievement of SVR was associated with a 56% reduction in the odds of extrahepatic mortality (odds ratio, 0.44; 95% confidence interval, 0.28 to 0.67), they report in Gut, online April 27.

SVR achievement was also associated with a 20.76-fold increase in the odds of complete remission and a 27.24-fold increase in the odds of improvement of cryoglobulinemic vasculitis, a 6.49-fold increase in the odds of objective response of lymphoproliferative diseases, as well as a 58% reduction in the odds of insulin resistance in patients without diabetes and a 66% reduction in the odds of diabetes at follow-up. All these findings were statistically significant.

The odds of major adverse cardiovascular events declined by 63% after SVR achievement, the odds of ischemic events declined by 30% and the odds of experiencing renal events declined by 85%. These differences were also significant.

Fatigue scores declined after achieving SVR, but there was no significant reduction in the presence of depression after SVR achievement.

"Higher quality data, and reporting over longer follow-up periods, will be required to thoroughly explore comprehensive HCV treatment strategies," the researchers conclude.

Dr. Nancy S. Reau from Rush University Medical Center, in Chicago, who recently reviewed the economic burden of extrahepatic manifestations of HCV, told Reuters Health by email, "Multiple health conditions (including all-cause mortality) have been linked to HCV. Viral eradication may have a strong impact in reducing a wide array of complications."

"We can view this two ways," she said. "The obvious is that therapy should be prioritized in patients with extrahepatic manifestations. This supports the recommendations in the American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of the Liver (EASL) guidelines. The other is that SVR may prevent non-liver associated complications."

Gilead supported this work through an unrestricted grant, and two of the four authors had ties to the company, which makes drugs for viral hepatitis.


Gut 2018.

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