Liver Disease Risk Remains for HCV Patients With Bleeding Disorders

Cas J. Isfordink

Despite the ability to cure hepatitis C virus (HCV) infections with direct-acting antivirals (DAA), there remains a risk of liver-related complications for patients with inherited bleeding disorders after the HCV is cured.

A team, led by Cas J. Isfordink, Van Creveldkliniek, Department of Benign Hematology, University Medical Center Utrecht, Utrecht University, identified liver-related complications during long-term chronic HCV infections and following sustained virological response (SVR) in patients with inherited bleeding disorders.

The Value of DAA

DAA treatments have gone a long way in curing HCV infections for patients with inherited bleeding disorders. However, there is not much data on the risk of liver-related complications after patients with inherited bleeding disorders are cured of HCV.

“Although successful HCV treatment is considered to substantially reduce the risk of liver-related complications, this risk is not entirely eradicated,” the authors wrote. “In the general HCV population, liver-related complications following SVR are more frequent after DAA-induced SVR than following interferon-induced SVR because in contrast to interferon, also patients with more advanced liver disease are eligible for DAA therapy.”

In the retrospective follow-up, the investigators examined patients with positive HCV antibodies with inherited bleeding disorders at a single center that provides care for approximately 50% of the Dutch population with hemophilia.

Data was collected on age, body mass index (BMI), hemophilia-related variables, alcohol use, hepatitis B virus and HIV co-infections, and date and cause of death for each patient.

The investigators sought primary endpoints of liver-related complications, including hepatocellular carcinoma (HCC), decompensated cirrhosis, bleeding gastroesophageal varices. Each liver-related complication was reported separately during chronic HCV and following SVR. The complications were stratified for interferon-based and DAA-based SVR.

A Risk Remains

Of the 381 patients included in the study, 81% (n = 309) of HCV antibody-positive patients developed a chronic HCV infection with a median follow-up of 44 years. Of this group, 12% (n = 36) developed a liver-related complication after a median of 31 years of chronic infection.

There were 199 patients with SVR, 97 of which were cured with interferon-based regimens and 102 of which were cured with DAA after a median infection duration of 29 years and 45 years, respectively.

After the follow-up period, 21% had advanced fibrosis and 42% had cirrhosis. After SVR, 4% (n = 7) of patients had a liver-related complication, the majority of which were HCC (n = 4).

The incidence of liver-related complications per 100 patient-years post-SVR follow-up was 0.2 for interferon-cured and 1.0 for DAA-cured patients (P = .01).

“Successful HCV treatment does not eliminate the risk of liver-related complications in persons with inherited bleeding disorders,” the authors wrote. “Due to higher baseline risk, incidence was higher after DAA than interferon-based SVR. We advise continuing HCC surveillance post-SVR in all with advanced fibrosis or cirrhosis.”

The study, “Liver-related complications before and after successful treatment of chronic hepatitis C virus infection in people with inherited bleeding disorders,” was published online in Haemophilia.