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Long Term Clinical Outcomes in Chronic Hepatitis C Patients Who Achieved SVR Following DAAs: A Decade Long
Gamal Shiha1,2, Ahmed Helmy3, Nabiel Mikhail1,4
1Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt.
Insights
Direct-acting antivirals (DAAs) significantly reduce mortality and slow disease progression in chronic hepatitis C virus (HCV) patients. This long-term study confirms DAAs improve liver function and prevent serious complications.
Area of Science:
- Hepatology
- Virology
- Public Health
Background:
- The long-term impact of direct-acting antivirals (DAAs) on chronic hepatitis C virus (HCV) patients requires further investigation.
- Previous studies have not fully elucidated the effects of DAAs on mortality, hepatocellular carcinoma (HCC), and decompensated cirrhosis in real-world settings.
Purpose of the Study:
- To evaluate the long-term outcomes of all-cause mortality, HCC incidence, and decompensated cirrhosis in HCV patients treated with DAAs.
- To assess the impact of advanced fibrosis on these outcomes in the DAA-treated cohort.
Main Methods:
- A prospective observational study of 3017 HCV patients treated with DAAs between 2015 and 2018.
- Exclusion criteria included decompensated liver disease, HBV/HIV co-infection, prior HCC, or severe comorbidities.
- Follow-up data, including clinical, biochemical, ultrasound, and liver stiffness measurements (LSM), were collected until the end of 2024. Kaplan-Meier curves and Cox models were used for analysis.
Main Results:
- The study recorded 593 deaths (2.58/100 person-years), 271 HCC cases (1.24/100 person-years), and 281 decompensated cirrhosis cases (1.30/100 person-years).
- Advanced fibrosis (F3-F4) was associated with increased mortality (HR: 1.72) and decompensation (HR: 2.23) but not HCC (HR: 1.17).
- Liver fibrosis showed reversal in 11.9%, improvement in 17.8%, stability in 50.5%, and progression in 19.8% of patients.
Conclusions:
- DAA treatment in chronic HCV patients leads to improved liver function and reduced long-term complications.
- The findings confirm the efficacy of DAAs in preventing mortality and slowing disease progression, even in patients with advanced fibrosis.
- This study reinforces the critical role of DAAs in the management of chronic HCV infection.
Abstract:
The long-term impact of direct-acting antivirals (DAAs) in chronic hepatitis C virus (HCV) patients remains debated. This study evaluates all-cause mortality, hepatocellular carcinoma (HCC), and decompensated cirrhosis in DAAs-treated patients enrolled in the 'Educate, Test, and Treat' programme. This prospective observational study included HCV patients treated at the Egyptian Liver Research Institute and Hospital (ELRIAH) from 2015 to 2018. Participants were recruited from 12 villages and followed until the end of 2024. Exclusions included decompensated liver disease, hepatitis B virus (HBV)/human immunodeficiency virus (HIV) co-infection, prior HCC, or severe comorbidities. Follow-up included clinical, biochemical, ultrasound, and liver stiffness measurements (LSM). Primary outcomes were all-cause mortality, HCC, and decompensated cirrhosis. Kaplan-Meier curves and Cox models analyse data. Of 3328 eligible patients, follow-up data were available for 3017 (53% male, mean follow-up: 84.5 ± 28.9 months). Advanced fibrosis (F3-F4) was present in 1125 (37.3%). The study recorded 593 deaths (2.58/100 person-years), 271 HCC cases (1.24/100 person-years), and 281 decompensated cirrhosis cases (1.30/100 person-years). Advanced fibrosis was associated with increased mortality (HR: 1.72, 95% CI: 1.46-2.03, p < 0.001) and decompensation (HR: 2.23, 95% CI: 1.74-2.85, p < 0.001) but not HCC (HR: 1.17, 95% CI: 0.92-1.49, p = 0.192). Fibrosis reversed in 11.9%, improved in 17.8%, remained stable in 50.5%, and progressed in 19.8%. This decade-long study confirms DAAs improve liver function, reduce mortality, and slow disease progression, reinforcing their role in preventing long-term complications.
