Hepatology Month in Review: December 2023

Although one might have expected December to come and go with little action heading into the new year, the final month of 2023 was anything but a lull in the field of hepatology. Shaped by research in hepatitis C virus (HCV) screening, the impact of treatment with direct-acting antivirals (DAAs) in different patient populations, and potential risk factors for liver diseases, December was an appropriate bookend to a historic year. To celebrate the end of 2023, HCPLive Hepatology has put together a month in review spotlighting some of our top content from December.

Putting an Emphasis on HCV Screening

HCV Screening, Care Model Intervention Improve Patient Outcomes

In this retrospective study, a team of investigators sought to assess the impact of automated routine screening as well as an interdisciplinary patient care model on diagnosis and treatment outcomes. To do so, they examined the electronic health records, self-tracking database from the FOCUS team, and medical charts of 83 patients screened and diagnosed with HCV at Jersey City Medical Center and linked to care at the Center for Comprehensive Care.

Upon analysis, there were no statistically significant differences in patients who completed treatment (P = .11) and patients who achieved SVR12 (P = .39) between the pre- and post-intervention groups, although differences were observed for patients lost to follow-up, documented appointments for initiation of HCV treatment, patients who answered follow-up calls, and medication reconciliation being completed and documented.

Study Highlights Lack of Hepatitis C Screening Despite Growing Prevalence

Findings from this study of patients seen at a safety net hospital in New York between 2012 and 2019 showed low HCV screening rates among patients who met guideline-recommended birth year criteria, a common trend in community health centers across the US.

Of 21,722 patients born between 1945 and 1965 seen in the hospital’s outpatient medical clinics, surgical clinics, emergency department, or for inpatient hospitalization or psychiatric encounters, 1858 (8.5%) individuals were screened for hepatitis C. Among them, 109 (5.9%) tested positive for HCV antibody and were subsequently tested for HCV RNA. This further testing showed 56 (3.0%) patients had active HCV infection with detectable RNA.

A Closer Look at Direct-Acting Antivirals

Study Explores Sex-Based Differences in Safety, Efficacy of DAAs in Clinical Trials

One of our top stories of the month breaks down results from a study examining data for adult patients treated at the approved DAA dosage and treatment duration from 40 phase 3 clinical trials submitted to the FDA to support an initial approval or major label change.

A total of 40 trials and 13,824 randomized participants were included in the study, of which 38% were female. The unadjusted and adjusted odds ratios for achieving SVR12 were similar, but investigators pointed out numerically more female patients experienced fatigue, headache, and gastrointestinal disorders compared to males. Of note, all adverse events were Grade 1 or 2 in severity and the difference between the proportion of females compared to males who developed these events was low.

Direct-Acting Antivirals Improve HCC-Free Survival, Liver Function in Patients with HCV Decompensated Cirrhosis

Results from this systematic review and meta-analysis showed treatment with DAAs resulted in 90% overall and HCC-free survival probabilities at 24 months for patients with HCV decompensated cirrhosis, with treatment also resulting in notable reductions in Model for End-Stage Liver Disease (MELD) scores indicative of improved liver function.

A total of 8 studies encompassing 3430 participants, including 2603 treated with DAAs and 1999 in the non-DAA group, were included in the systematic review. Upon analysis, the DAA group exhibited a greater overall survival rate than the control group (P < .001). Further analysis revealed patients with decompensated HCV cirrhosis who received DAA treatment had a 28% lower risk of HCC than the control patients (hazard ratio [HR], 0.72; 95% Confidence interval [CI], 0.52-1.00; P = .05).

Identifying MASLD Risk Factors

Micronutrient Intake Associated with Risk of MAFLD

This cross-sectional study leverages dietary recall interview data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) to provide an overview of the association between micronutrient intake and risk of metabolic dysfunction-associated fatty liver disease (MAFLD), with findings suggesting high copper intake and moderate iron intake may be associated with a decreased risk of MAFLD regardless of gender or the presence of diabetes or hypertension.

Having copper intake in the third and fourth quartiles (Odds ratio [OR], 0.67; 95% CI, 0.49-0.91 and OR, 0.58; 95% CI, 0.43-0.78, respectively) and iron intake in the second and third quartiles (OR, 0.63; 95% CI, 0.44-0.91 and OR, 0.59; 95% CI, 0.40-0.85, respectively) were found to be associated with decreased odds of MAFLD compared to participants in the first quartile.

Environmental Exposure to Toxic Metals May Increase Risk of MASLD, Study Finds

Another cross-sectional study, again using data from NHANES, found that exposure to toxic metals may be associated with an increased risk of metabolic dysfunction-associated steatotic liver disease (MASLD).

Results showed participants in the third quartile (OR, 1.20; 95% CI, 0.99-1.45; P = .068) and fourth quartile (OR, 1.24; 95% CI, 1.02-1.50; P = .031) for blood selenium levels faced a greater risk of MASLD compared to those in the first quartile, suggesting greater blood selenium levels were associated with an increased likelihood of MASLD. Blood lead exposure was also positively correlated with MASLD risk in the second quartile group (OR, 1.21; 95% CI, 1.00-1.46; P = .049).