Liver and Cardiovascular Mortality After Hepatitis C Virus Eradication by DAA: data from RESIST‐HCV Cohort

Real world evidence on the course of Hepatitis C Virus (HCV) chronic liver disease after Sustained Virologic Response (SVR) obtained with direct-acting antiviral drugs (DAAs) are still limited, and the effects on mortality remain unclear. We evaluated the post-treatment survival of 4,307 patients in the RESIST-HCV cohort (mean age 66.3±11.6 years, 56.9% males, 24.7% chronic hepatitis, 66.9% Child-Pugh A cirrhosis and 8.4% Child-Pugh B cirrhosis) treated with DAAs between March 2015 and December 2016 and followed for a median of 73 weeks (range 16-152). Proportional cause-specific hazard regression for competing risks was used to evaluate the survival and to assess the predictors of liver and cardiovascular death. Overall, 94.7% of patients achieved SVR while 5.3% were HCV-RNA positive at last follow-up. Sixty-three patients (1.4%) died during the observation period. SVR was associated with a decreased risk of liver mortality (hazard ratio, HR0.09, beta -2.37, p<0.001). Also, platelet count (HR 0.99, beta-0.01, p=0.007) and albumin value (HR 0.26, beta -1.36 p=0.001) were associated with liver mortality by competing risk analysis. SVR was associated with a reduced risk of cardiovascular mortality regardless of presence of cirrhosis (HR 0.07,beta-2.67,p<0.001). Presence of diabetes (HR 3.45, beta 1.24,p=0.014) and chronic kidney disease class ≥ 3 (HR 3.60,beta 1.28,p=0.016) were two factors independently associated with higher risk of cardiovascular mortality. Patients with SVR to a DAA therapy have a better liver and cardiovascular survival and the effects of HCV eradication are most evident in patients with compensated liver disease.