HCV infection is the underlying cause of chronic hepatitis C (CHC), liver cirrhosis, and liver cancer or hepatocellular carcinoma (HCC). In 2019, more than 2,90,000 people died from HCV-related diseases. Recent medical advances have made a new breakthrough treatment available for patients with hepatitis C. DAAs that block HCV replication have dramatically changed the treatment approach with approximately 90% effective antiviral response rates. However, it is unclear whether DAAs affect the severity of disease burden caused by liver fibrosis.
To answer this critical question, Associate Professor Seungbong Han from the Department of Biostatistics at Korea University College of Medicine, South Korea collaborated with colleagues at several centers in South Korea to assess the impact of DAAs on the burden of fibrotic disease in patients with chronic HCV infection. Their study was made available online on May 30, 2024 and published in volume 73 of the journal eClinical Medicine on July 1, 2024.
For individuals, early detection and effective treatment would mean fewer complications, better health outcomes and improved quality of life. Successful strategies could serve as models for other countries with high hepatitis C prevalence, leading to global improvement in hepatitis C management.”
Seungbong Han, Associate Professor, Department of Biostatistics, Korea Medical University
The team collected medical records of 11,725 patients with HCV infection from 29 institutions in South Korea. They compared individual participant data from 3,261 untreated with 8,464 DAA-treated patients, over a follow-up period of 27.5 months. To assess the severity and outcomes of liver disease, they analyzed noninvasive reports of liver fibrosis and stiffness and assessed the risk of liver cancer, liver function impairment, and death.
They observed that DAA treatment reduced the burden of fibrotic disease and reduced the risk of the disease progressing to cancer or cirrhosis, increasing life expectancy. The differences were more pronounced in the 40-60 age groups.
One of the limitations of this study is the reliance on non-invasive tests to measure liver fibrosis. “Noninvasive scores and liver stiffness are not accurate for detecting reduced fibrosis after sustained viral response in patients with HCV infection, because improvements in noninvasive tests usually reflect the expected reduction in necroinflammation but not fibrosis.” Associate Professor Han explains.
How important are liver biopsies for accurate evaluation?
Liver biopsy is the gold standard for accurate measurement and staging of liver fibrosis. However, the risks and expertise required to perform this demanding process limit reproducibility. Despite the limitation, this study provides scientific evidence that the use of DAA is a critical strategy to reduce the disease burden underlying liver fibrosis and improve clinical outcomes.
Sustainability in healthcare requires evidence-based allocation of healthcare resources. The findings of this study merit public health campaigns to raise awareness of hepatitis C and its risks, which will promote nationwide screening for HCV positivity. Early intervention with advanced antiviral approaches is likely to reduce healthcare costs associated with treating advanced liver diseases such as cancer or cirrhosis, freeing up resources for other critical healthcare needs.
“Our study can help improve public health, health care systems, and individual lives by encouraging the development of early intervention and effective treatment strategies for HCV infection.” Associate Professor Han concludes.
Source:
Journal Reference:
Sohn, W., et al. (2024). Impact of direct-acting antivirals on the disease burden of hepatitis C virus infection in South Korea in 2007–2021: a national, multicenter, retrospective cohort study. EClinical Medicine. doi.org/10.1016/j.eclinm.2024.102671.
