Association between antiviral treatment and extrahepatic outcomes in patients with hepatitis C virus infection.
OBJECTIVE
To elucidate the association between antiviral therapy and extrahepatic outcomes in individuals infected with HCV.


METHODS
This nationwide cohort study screened 293,480 Taiwanese residents with HCV infection and excluded those with substantial comorbidity. A total of 12,384 eligible patients who had received pegylated interferon plus ribavirin between 1 October 2003 and 31 December 2010 were enrolled in the treated cohort; they were matched 1 : 2 with 24,768 untreated controls in the propensity score and post-diagnosis treatment-free period. The incidences of end-stage renal disease (ESRD), acute coronary syndrome (ACS), ischaemic stroke and catastrophic autoimmune diseases were calculated after adjustment for competing mortality.


RESULTS
The treated and untreated cohorts were followed up for a mean (±SD) duration of 3.3 (±2.5) and 3.2 (±2.4) years, respectively, until 31 December 2011. The calculated 8-year cumulative incidences of ESRD, ACS, ischaemic stroke and autoimmune catastrophes between treated and untreated patients were 0.15% vs. 1.32% (p<0.001), 2.21% vs. 2.96% (p=0.027), 1.31% vs. 1.76% (p=0.001) and 0.57% vs. 0.49% (p=0.816), respectively. Multivariate-adjusted Cox regression revealed that antiviral treatment was associated with lower risks of ESRD (HR 0.15; 95% CI 0.07 to 0.31; p<0.001), ACS (HR 0.77; 95% CI 0.62 to 0.97; p=0.026) and ischaemic stroke (HR 0.62; 95% CI 0.46 to 0.83; p=0.001), but unrelated to autoimmune catastrophes. These favourable associations were invalid in incompletely treated patients with duration <16 weeks.


CONCLUSIONS
Antiviral treatment for HCV is associated with improved renal and circulatory outcomes, but unrelated to catastrophic autoimmune diseases.
Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan Center for Database Research, E-Da Hospital, Kaohsiung, Taiwan School of Medicine, I-Shou University, Kaohsiung, Taiwan.
Yao-Chun
YC
Hsu
Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.
Hsiu J
HJ
Ho
Department of Epidemiology, Brown University, Providence, Rhode Island, USA.
Yen-Tsung
YT
Huang
Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.
Hsi-Hao
HH
Wang
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ming-Shiang
MS
Wu
School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan.
Jaw-Town
JT
Lin
Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan College of Public Health, China Medical University, Taichung, Taiwan Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan.
Chun-Ying
CY
Wu
D054058:Acute Coronary Syndrome / Q000150:complications; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001327:Autoimmune Diseases / Q000150:complications; D004359:Drug Therapy, Combination; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a
ANTIVIRAL THERAPY; HEPATITIS C