for hepatitis C, especially if it leads to a cure, is associated with a reduced
risk of cardiovascular events such as congestive heart failure, heart attacks
and strokes, according to research presented at IDWeek 2018 this month in San
large study of US veterans, those treated with new direct-acting antivirals
(DAAs) were about half as likely to experience cardiovascular events as
untreated individuals (16 vs 30 events per 1000 person-years of follow-up,
years or decades, chronic hepatitis C virus (HCV) infection can lead to serious
liver disease including cirrhosis, hepatocellular carcinoma and the need for a
liver transplant. But HCV infection can have detrimental manifestations
elsewhere in the body as well. The reasons for this are not full understood, as
the virus itself primarily infects liver cells, but it could be related to chronic
- compensated cirrhosis
The earlier stage of
cirrhosis, during which the liver is damaged but still able to perform most of
its functions. See also ‘cirrhosis’ and ‘decompensated cirrhosis’.
- sustained virological response (SVR)
Undetectable hepatitis C RNA after treatment has come to an end. Usually SVR refers to RNA remaining undetectable for 24 weeks (six months) after ending treatment and is considered to be a cure. SVR4 and SVR12 refer to RNA remaining undetectable for 4 and 12 weeks respectively.
studies have found that people with hepatitis C are more
prone to developing cardiovascular conditions such as coronary
artery disease, peripheral vascular disease, myocardial infarction and stroke;
however, other studies have not seen this association.
body of evidence shows that HCV treatment can help reverse this increased risk.
study from France, for example, found that curing hepatitis C reduces the risk of cardiovascular events in people with
compensated cirrhosis. But again, some large studies from the interferon era
did not see a similar benefit.
It IDWeek, Prof Adeel Butt of Weill Cornell Medical College in New York presented
findings from an analysis comparing the risk of new cardiovascular events among
treated and untreated US veterans with hepatitis C in the ERCHIVES
(Electronically Retrieved Cohort of HCV-Infected Veterans) database.
previous ERCHIVES analysis by Butt's team, which included more than 82,000 veterans with hepatitis
C and over 89,500 uninfected veterans, found that having HCV was independently
associated with a 27% increase in the risk of coronary artery disease events.
new analysis, the researchers started with 242,680 veterans with chronic HCV
infection. They excluded those with HIV or hepatitis B virus co-infection and
those with pre-existing cardiovascular disease at baseline. Treated people
were also excluded if they did not have HCV RNA measurements to determine
whether they achieved sustained virological response (SVR), or undetectable
viral load after completion of therapy, which is considered a cure.
population included 4436 people treated with pegylated interferon plus
ribavirin and the same number of matched control subjects who never received
treatment, as well as 12,667 people treated with DAAs,
again with the same number of matched untreated controls. People who had been
treated on separate occasions with both pegylated interferon/ribavirin and DAAs
were excluded. Across all treated people, the overall SVR rate was 76%.
groups, most participants (96%) were men, over half were white, about a quarter
were African American and the median age was approximately 58 years.
Cardiovascular risk factors were common, including current or past smoking
(66%), obesity (32%), high blood pressure (53%), diabetes (about 9%) and use of
looked at new cardiovascular events occurring at least 12 weeks after the start
of HCV treatment: acute myocardial infarction, stroke, unstable angina (chest
pain indicating inadequate blood reaching the heart muscle), congestive heart
failure, peripheral vascular disease and the need for coronary angioplasty or
coronary artery bypass procedures.
adjusting for cardiovascular risk factors, the incidence of cardiovascular
events was 30.4 per 1000 person-years among untreated individuals, compared
with 20.8 per 1000 person-years among those who received treatment (p <
this down by type of treatment, the incidence rates were 23.5 and 16.3 per
1000 person-years, respectively, for those treated with pegylated
interferon/ribavirin and DAAs (p < 0.0001). Combing both types of treatment,
cardiovascular events occurred in 19.1 per 1000 people who achieved SVR and 22.5
per 1000 who were not cured (p < 0.0001).
months of follow-up, treated individuals had a
significantly longer duration of survival without cardiovascular events.
Based on these findings, Butt and colleagues concluded, "HCV
treatment is associated with a significantly reduced risk of cardiovascular events. Those treated with a DAA
regimen and those who achieve SVR have a greater benefit."