Antiviral treatment reduces risk of cardiovascular outcomes in patients with hepatitis C

This article originally appeared on our sister site HCPLive.

Hepatitis C virus (HCV) patients using antiviral therapy have a significantly reduced risk of cardiovascular outcomes and mortality, according to a recent systematic review and meta-analysis.

Antiviral therapy use is associated with a reduced risk of cardiovascular death, myocardial infarction, all-cause mortality, and peripheral arterial disease.¹

“Hepatitis C infection has been shown to be associated with a higher risk of atherosclerotic cardiovascular disease. However, the use of antiviral therapy and the risk of cardiovascular disease have not been fully established due to limited literature,” the researchers wrote .¹

The World Health Organization estimates that 58 million people worldwide have chronic hepatitis C virus.² Although the infection does not always require treatment, antiviral drugs are often prescribed for chronic hepatitis C to clear the virus from the blood, slow the progression of liver inflammation and scarring, and reduce the chance of developing cirrhosis and liver cancer.³

To assess the association between antiviral therapy use and cardiovascular outcomes after HCV infection, Dhrubajyoti Bandyopadhyay, MBBS, MD, a senior investigator at Massachusetts General Hospital, and a team of researchers conducted a systematic literature search in PubMed, Embase, and Scopus , to understand prospective and retrospective cohort studies of HCV patients aged ≥18 years. To be included, studies needed to have two arms and include data on the risk of any cardiovascular disease, stroke, peripheral arterial disease, myocardial infarction, and all-cause mortality. Reviews, case reports, case series, studies on animals or patients <18 years of age, single-arm studies, studies without HCV infection or without antiviral treatment, and studies without outcomes of interest were excluded.¹

An initial database search yielded 974 articles, of which 175 studies were excluded after the researchers removed duplicates. Based on the inclusion and exclusion criteria, an additional 778 studies were excluded from the initial screening. The researchers conducted a full-text review of the remaining 21 articles and excluded 13 because the participants did not have HCV, did not have the expected outcome, or had only a single arm. A total of 8 studies met the eligibility criteria and were included in the meta-analysis, including 394,452 patients with HCV, 111,076 patients in the antiviral treatment group, and 283,376 patients in the non-antiviral treatment group.¹

The primary outcome was the risk of any cardiovascular disease. Secondary outcomes of interest included the incidence of stroke, peripheral arterial disease, myocardial infarction, and all-cause mortality.¹

Pooled analysis of the primary outcome showed that antiviral treatment was associated with a reduced risk of any cardiovascular death (hazard ratio (HR), 0.55; 95% confidence interval (CI), 0.41-0.75; ask < .001) compared with the non-antiviral treatment group. The researchers noted the risk of all-cause death (HR, 0.38; 95% CI, 0.32-0.46; ask < .001; I2 = 87.85%), myocardial infarction (HR, 0.62; 95% CI, 0.41–0.94; ask = .02; I2 = 4.48%) and peripheral arterial disease (HR, 0.62; 95% CI, 0.41–0.93; ask = .02; I2 = 13.40%) was also significantly lower in patients using antiviral therapy.¹

The high degree of heterogeneity prompted researchers to perform sensitivity analyzes for cardiovascular death, all-cause mortality, and stroke. After performing a sensitivity analysis by excluding one study at a time, the results for cardiovascular death and all-cause mortality remained significant and unchanged (ask < .05), but after excluding the prospective 2022 cohort, researchers observed a statistically significant reduction in the risk of stroke in the AVT group compared with the non-antiviral group (HR, 0.71; 95% CI, 0.60-0.85; ask < .001).¹

Subgroup analysis based on the type of antiviral therapy, including direct-acting antiviral therapy (DAA) and interferon-based therapy (IBT), showed no significant subgroup differences in the risk of cardiovascular death between the two.ask = .96). The researchers noted that studies using IBT showed a reduced risk of stroke compared with non-antiviral therapy (HR, 0.71; 95% CI, 0.58-0.88), while studies using DAA therapy compared with non-antiviral therapy did not show a significant reduction in stroke risk. difference (HR, 0.94; 95% CI) CI, 0.51–0.73).¹

“In our study, we found that (antiviral treatment) significantly reduced our primary outcome, which was any cardiovascular disease, compared with the (no antiviral treatment) group. Compared with the (no antiviral treatment) group Secondary outcomes (i.e., myocardial infarction, all-cause mortality, and (peripheral artery disease)) were also significantly lower in the (antiviral treatment) group than in the antiviral treatment group,” the researchers concluded.¹

refer to:

1. Jaiswal V, Ang SP, Hanif M, et al. Cardioprotective effects of antiviral therapy in patients with hepatitis C infection: a meta-analysis. Int J Cardiol Heart Vasc. doi:10.1016/j.ijcha.2023.101270.
2. World Health Organization. Hepatitis C Newsroom. July 18, 2023. Accessed 9 October 2023. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
3. American Liver Foundation. Treating hepatitis C. Hepatitis C Information Center. Accessed: October 9, 2023. https://liverfoundation.org/liver-diseases/viral-hepatitis/hepatitis-c/treating-hepatitis-c/