Treatment is associated with lower morbidity and mortality.

Short-course oral direct-acting antiviral agents result in virological cure for most patients with chronic hepatitis C regardless of age, presence of cirrhosis and other comorbidities. In this retrospective cohort study, researchers used a large nationwide clinical database and evaluated whether direct-acting antiviral treatment (without interferon) is associated with lower risks for liver-related and nonliver-related morbidity and death in patients with chronic hepatitis C.

A total of 246,000 patients with chronic hepatitis C (mean age, 59 years) were included in the study; of these, 205,000 were untreated and 41,000 received one or more prescriptions for direct-acting antiviral medications without interferon. Adjusted for numerous variables, direct-acting antiviral treatment was associated with significantly lower risks for liver decompensation (by 64%), death (by 57%) and hepatocellular carcinoma (by 27%); risks for diabetes, chronic kidney disease, nonliver-related cancer and cardiovascular disease were also lower. Lower risks for most of these conditions were noted in both patients without cirrhosis and those with compensated or decompensated cirrhosis.

Comment: Oral direct-acting antiviral treatment is associated with lower risks for liver-related and nonliver-related morbidity and death in patients with chronic hepatitis C. Direct-acting antiviral treatment should be offered to virtually all patients with chronic hepatitis C, regardless of disease stage or financial status. The study findings also emphasise the importance of hepatitis C screening for early diagnosis and treatment.

Paul S. Mueller

Ogawa E, et al. Association of direct-acting antiviral therapy with liver and nonliver complications and long-term mortality in patients with chronic hepatitis C. JAMA Intern Med 2023; 183: 97-105.