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Long‐term outcomes of viral eradication in patients with hepatitis C virus infection and mild hepatic fibrosis
Author(s) -
Kumada Takashi,
Toyoda Hidenori,
Yasuda Satoshi,
Tada Toshifumi,
Ito Takanori,
Tanaka Junko
Publication year - 2021
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.13562
Subject(s) - medicine , hazard ratio , gastroenterology , hepatitis c virus , population , confidence interval , proportional hazards model , fibrosis , viral hepatitis , hepatitis c , immunology , virus , environmental health
Abstract The impact of antiviral therapy on clinical outcomes in patients with hepatitis C virus (HCV) infection and mild liver fibrosis (FIB‐4 score <1.45) is not well understood. We aimed to clarify the impact of viral eradication on hepatocarcinogenesis and mortality in patients with mild fibrosis.The subjects were 657 patients who achieved sustained virologic response (SVR) (Clearance group) and 586 patients who did not receive antiviral therapy or did not achieve SVR (No clearance group). We applied inverse probability weighting because the groups had different baseline characteristics. Multivariate proportional hazards models were used to analyse factors associated with hepatocarcinogenesis and mortality using a time‐dependent covariate. In addition, we compared the mortality rate of the Clearance group stratified by age to the mortality rate of the general population.Clearance of HCV RNA was significantly associated with hepatocarcinogenesis and all‐cause, liver‐related and non–liver‐related mortality (adjusted hazard ratios [95% confidence interval], 0.2653 [0.1147–0.6136, p = 0.0019], 0.3416 [0.2157–0.5409, p < 0.0001], 0.2474 [0.0802–0.8917, p = 0.0381] and 0.4118 [0.2449–0.6925, p = 0.0008], respectively). The Clearance group had significantly higher mortality than the general population matched by age, sex and follow‐up duration ( p < 0.0001). However, there were no significant differences between patients who achieved SVR before age 50 and the general population matched by age, sex and follow‐up duration ( p = 0.1570). HCV eradication in patients with mild fibrosis reduces liver‐related and non–liver‐related mortality. If HCV is eradicated before age 50, prognosis is likely be similar to that of the age‐matched and sex‐matched general population. (249 words).