DAA Treatment Reduces Risk of Death for Hepatitis C Patients

Naveed Z. Janjua, MBBS

Direct-acting antivirals (DAA) reduce the risk of all-cause mortality, as well as mortality from liver disease and drug use for patients with hepatitis C virus (HCV) infections.

A team, led by Naveed Z. Janjua, MBBS, DrPH, BC Centre for Disease Control Clinical Professor, School of Population and Public Health, University of British Columbia, evaluated the effect of sustained virologic response (SVR) from direct acting antiviral therapy on all-cause, liver- and drug-related mortality.

The Patient Population

In the population-based cohort, the researchers examined data of from the BC Hepatitis Testers Cohort of individuals tested for hepatitis C since 1990, linked with data on medical visits, hospitalizations, prescription drugs, and mortality.

The researchers followed individuals who received DAAs (n = 10,855; SVR, 10,426) and participants who did not receive HCV treatment to death or December 31, 2019 (n = 10,855). The median follow-up time was 2.2 years.

The team used inverse probability of treatment weighting to balance the baseline profile of treated and untreated individuals. They also performed multivariable proportional hazard modeling to assess the effects of direct acting antiviral treatment on mortality.

Mortality Rate

Overall, the all-cause mortality rate was 19.5 per 1000 person-years among the subgroup of patients with a sustained virologic response (deaths = 552). The all-cause mortality rate—86.5 per 1000 person-years—was significantly higher in the no-SVR group (deaths = 96), but even higher—99.2 per 1000 person-years—among the untreated group (deaths = 2133).

Using the multivariable model, SVR was linked to significant reductions in all-cause (aHR, 0.26; 95% CI, 0.17-0.21), liver (subdistribution [as]HR, 0.22; 95%CI, 0.18-0.27), and drug-related mortality(asHR, 0.26; 95%CI, 0.21-0.32) compared to no-treatment.

There was also a higher risk of liver-related mortality in older patients and individuals with cirrhosis. On the other hand, younger age, injection use, problematic alcohol use, and HIV/HBV co-infections were linked to a higher risk of drug-related mortality.

“DAA treatment is associated with a substantial reduction in all-cause, liver- and drug-related mortality,” the authors wrote. “The association of IDU and related syndemic factors with a higher risk of drug-related mortality calls for an integrated social support, addiction, and HCV care approach among people with IDU.”

DAAs Following Liver Transplantation

Earlier this year, researchers found a regimen of direct-acting antiviral treatments is safe and efficacious against HCV infections following liver transplantation.

HCV infections represent 1 of the most frequent causes of liver transplantations globally. Patients with HCV viremia at the time of transplantation universally develop recurrent HCV in the allograph, which causes accelerated fibrosis and graft loss.

The safety profile was positive, with no severe adverse effects observed.

Ribavirin was used in 82% of the patients. While 23.9% of this patient subgroup suffered from adverse effects, the majority were deemed mild.

In addition, the median follow-up after the transplant surgery was 55 months (IQR, 43-51), with a global and graft survival at 1 and 3 years of 100%.

The study, “Impact of direct-acting antivirals for HCV on mortality in a large population-based cohort study,” was published online in the Journal of Hepatology.