Rates of HCV-related decompensated cirrhosis and liver-related mortality have decreased in New South Wales since direct-acting antiviral (DAA) therapy became available.
The evidence for longer-term benefit beyond sustained virological response (SVR) should further encourage efforts to boost uptake of the antivirals, say researchers from the Kirby Institute, Sydney.
They note that about 24% of the estimated population with chronic HCV infection has received DAA therapy in Australia.
Their study in the Journal of Hepatology compared HCV notifications, hospital admissions and mortality between the pre-DAA (2001-2014) and DAA eras (2015-2017).
It found rates of HCV-related decompensated cirrhosis, hepatocellular carcinoma (HCC), and all-cause mortality had been consistently increasing before the introduction of DAAs.
“Over the decade prior to DAA therapy introduction in Australia, the numbers of people with HCV in New South Wales hospitalised for decompensated cirrhosis, HCC, and dying following these end-stage liver disease complications or all-cause mortality increased by two to three-fold,” said study authors, led by epidemiologists led by Dr Maryam Alavi.
However since the the introduction of DAAs – which were made available on the PBS in March 2016 – rates of HCV-related decompensated cirrhosis and liver-related mortality have decreased while HCC diagnosis and all-cause mortality have plateaued.
The study authors said between 2015 and 2017 there were declines of 21% in decompensated cirrhosis diagnoses and 17% in liver-related deaths.
“Compared to model-projected diagnoses and mortality numbers, in the DAA era, an estimated 248 diagnoses of decompensated cirrhosis, 155 diagnoses of HCC, 434 liver-related deaths, and 372 all-cause deaths were prevented.”
The study found the largest reduction in decompensated cirrhosis was in older patients born before 1967 and in those with no history of alcohol-use disorder.
Females and older people had the highest relative reduction in liver-related mortality.
The findings are consistent with mathematical modelling predictions that liver-related mortality would decrease with DAA therapy.
The researchers noted also that alcohol-use disorder was independently associated with liver-related mortality and a less dramatic decline in decompensated cirrhosis after the introduction of DAA therapy.
Possible explanations were lower uptake of DAA therapy in this population and/or liver disease progression despite DAA therapy.
“Our findings provide important evidence to support continued DAA scale-up in order to achieve hepatitis C elimination in the coming decades,” they wrote.
“However, heavy alcohol use remains an important risk factor for liver disease among people with hepatitis C. To ensure the benefits of new antiviral treatments will not be compromised, management of major co-morbidities, including heavy alcohol use must improve among people with hepatitis C.”