In the Journals

HCV clearance reduces diabetes, kidney disease, stroke risk

Sustained virologic response after treatment for hepatitis C correlated with a reduced risk for several extrahepatic manifestations including type 2 diabetes, chronic kidney disease, and mood and anxiety disorders.

Carmine Rossi, MD, from the British Columbia Center for Disease Control in Vancouver, British Columbia, and colleagues wrote that for infected individuals, the presence of extrahepatic manifestations connected to HCV may be as high as 31%. Further, direct medical costs associated with these complications can range from $72 million to $443 million.

“We, along with others, have demonstrated that SVR produces important benefits that extend outside the liver and reduce extrahepatic morbidity and mortality in the chronic HCV-infected population, independent of liver disease severity,” they wrote. “Successful HCV treatment may also not only reduce the incidence of [extrahepatic manifestations (EHMs)], but reduce health care resource utilization associated with these long-term chronic conditions.”

Rossi and colleagues retrospectively analyzed data from 10,264 patients who had initiated interferon-based therapies for HCV between April 1999 and July 2014 and were still alive and did not undergo retreatment within 24 weeks. Fifty-nine percent achieved SVR.

Multivariate analysis revealed a correlation between SVR and a reduced risk for type 2 diabetes (aHR = 0.65; 95% CI, 0.55-0.77), CKD or end-stage renal disease (aHR = 0.53; 95% CI, 0.43-0.65), stroke (aHR = 0.73; 95% CI, 0.49-1.09), and mood and anxiety disorders (aHR = 0.82; 95% CI, 0.71-0.95).

In contrast, SVR did not correlate with a reduced risk for ischemic heart disease, major adverse cardiac events or rheumatoid arthritis.

While the correlation between SVR and reduced risks for the above extrahepatic manifestations were overall consistent regardless of birth cohort, sex, injection drug history and HCV genotype, the researchers found more pronounced protective effects in some individuals.

Specifically, SVR correlated with a greater reduced risk for diabetes, CKD and ESRD, stroke, and mood and anxiety disorders among those without cirrhosis than those with cirrhosis. The risk for CKD or ESRD was lower in women (aHR = 0.39; 95% CI, 0.28-0.56) compared with men (aHR = 0.63; 95% CI, 0.48-0.82) and in those with no history of injection drug use (aHR = 0.48; 95% CI; 0.38-61) compared with those with such a history (aHR = 0.77; 95% CI, 0.49-1.22).

Rossi and colleagues noted that, “it remains to be seen if viral eradication from interferon-based therapies, as compared to all-oral DAAs, has a different effect on the incidence of long-term clinical outcomes, independent from the fact that patients with preexisting comorbid conditions are now eligible to receive treatment.”

They concluded, however, that these findings suggest that expanded HCV treatment access may reduce the growing burden and health care resource use for chronic extrahepatic disease. – by Talitha Bennett

Disclosures: Rossi reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.

Sustained virologic response after treatment for hepatitis C correlated with a reduced risk for several extrahepatic manifestations including type 2 diabetes, chronic kidney disease, and mood and anxiety disorders.

Carmine Rossi, MD, from the British Columbia Center for Disease Control in Vancouver, British Columbia, and colleagues wrote that for infected individuals, the presence of extrahepatic manifestations connected to HCV may be as high as 31%. Further, direct medical costs associated with these complications can range from $72 million to $443 million.

“We, along with others, have demonstrated that SVR produces important benefits that extend outside the liver and reduce extrahepatic morbidity and mortality in the chronic HCV-infected population, independent of liver disease severity,” they wrote. “Successful HCV treatment may also not only reduce the incidence of [extrahepatic manifestations (EHMs)], but reduce health care resource utilization associated with these long-term chronic conditions.”

Rossi and colleagues retrospectively analyzed data from 10,264 patients who had initiated interferon-based therapies for HCV between April 1999 and July 2014 and were still alive and did not undergo retreatment within 24 weeks. Fifty-nine percent achieved SVR.

Multivariate analysis revealed a correlation between SVR and a reduced risk for type 2 diabetes (aHR = 0.65; 95% CI, 0.55-0.77), CKD or end-stage renal disease (aHR = 0.53; 95% CI, 0.43-0.65), stroke (aHR = 0.73; 95% CI, 0.49-1.09), and mood and anxiety disorders (aHR = 0.82; 95% CI, 0.71-0.95).

In contrast, SVR did not correlate with a reduced risk for ischemic heart disease, major adverse cardiac events or rheumatoid arthritis.

While the correlation between SVR and reduced risks for the above extrahepatic manifestations were overall consistent regardless of birth cohort, sex, injection drug history and HCV genotype, the researchers found more pronounced protective effects in some individuals.

Specifically, SVR correlated with a greater reduced risk for diabetes, CKD and ESRD, stroke, and mood and anxiety disorders among those without cirrhosis than those with cirrhosis. The risk for CKD or ESRD was lower in women (aHR = 0.39; 95% CI, 0.28-0.56) compared with men (aHR = 0.63; 95% CI, 0.48-0.82) and in those with no history of injection drug use (aHR = 0.48; 95% CI; 0.38-61) compared with those with such a history (aHR = 0.77; 95% CI, 0.49-1.22).

Rossi and colleagues noted that, “it remains to be seen if viral eradication from interferon-based therapies, as compared to all-oral DAAs, has a different effect on the incidence of long-term clinical outcomes, independent from the fact that patients with preexisting comorbid conditions are now eligible to receive treatment.”

They concluded, however, that these findings suggest that expanded HCV treatment access may reduce the growing burden and health care resource use for chronic extrahepatic disease. – by Talitha Bennett

Disclosures: Rossi reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.