Nonischemic cardiomyopathy related to pegylated interferon and ribavirin

Comparing the Risk of Poor Outcomes Among Hepatitis C-Infected, Cured, and Never-Infected Controls

Background and Aims

Studies show decreased rates of poor outcomes after hepatitis C virus (HCV) cure. However, there are no data comparing risk of poor outcomes to that of HCV never infected; results that could have implications for those who may not need ongoing specialty follow-up after cure.

Methods

Retrospective cohort study conducted among Kaiser Permanente Northern California adults ages 18 and up between 2002 and 2019. Three cohorts were identified: 1) chronic HCV, 2) HCV cured, and 3) every chronic HCV and HCV-cured individual was matched by age, sex and race-ethnicity to 3 HCV negative controls. Outcomes of interest were cirrhosis, decompensated cirrhosis, hepatocellular carcinoma (HCC) and all-cause mortality. A low-risk group of HCV cured individuals without significant liver disease and/or concomitant liver disease cofactor(s) were identified.

Results

We identified 21,184 chronic HCV, 11,950 HCV cure, and 99,402 control individuals. Five-year cumulative incidence of cirrhosis, decompensated cirrhosis, HCC and all-cause mortality was 10% vs 3.6% vs 0.8%, 12% vs 2.6% vs 0.6%, 3.9% vs 1.6% vs 0.07%, and 14% vs 2.8% vs 2.2% for chronic HCV, HCV cure, and control individuals, respectively (log-rank P < .01 for all). Compared to controls, HCV cured low-risk individuals had numerically similar 5-year cumulative incidence of cirrhosis, decompensated cirrhosis, HCC and all-cause mortality (1.2% vs 0.8%, P < .01; 0.9% vs 0.6%, P < .01; 0.5% vs 0.1%, P < .01; 1.7% vs 2.2%, P < .01).

Conclusion

HCV cure provides significant health benefits but does not universally return risk of poor outcomes to that of the general population. A simple stratification at the time of HCV cure could identify low-risk individuals who can potentially be discharged from specialty clinics/HCC surveillance.

Effect of Hepatitis C Virus Infection on Heart Transplants in the Current Era

BACKGROUND

The effect of hepatitis C virus (HCV) infection in recipients or donors on heart transplants is less known in the current era after the introduction of direct-acting antiviral agents (DAAs) in 2011.

METHODS

Using the United Network for Organ Sharing registry, 24 871 adult heart transplant recipients between 2005 and 2019 were identified. The trend in prevalence of HCV infected recipients and in utilization of HCV infected donors and their effect on the transplant outcomes were investigated in the past era versus the current era separated by 2011, using Cox proportional hazard regression.

RESULTS

HCV antibody positive recipients (n=520, 2.1%) had stable prevalence (P=0.18). They had a lower survival estimate when compared to HCV antibody negative recipients in the past era (55.3% versus 70.9% at 7 years; hazard ratio (HR), 1.56; 95% confidence interval (CI), 1.27-1.91; P<0.001), however not in the current era (73.1% versus 71.5% at 7 years; HR, 1.00; 95% CI, 0.75-1.32; P=0.98) (Pinteraction<0.001). Organ use from HCV antibody positive donors (n=371, 1.5%) was concentrated in the recent years (P<0.001) and provided the similar survival estimate up to 2 years (84.2% versus 87.6%; HR, 0.97; 95% CI, 0.65-1.44; P=0.87). The similar findings were confirmed with a subgroup cohort with positive nucleic acid amplification test (NAT).

CONCLUSIONS

Positive HCV antibody in recipients did not adversely affect the long-term transplant outcomes in the current era. Graft utilization from positive HCV antibody or NAT positive donors are rapidly more prevalent and appeared to be promising up to 2 years posttransplant.

Pegylated Interferon-α Plus Ribavirin Therapy Improves Left Ventricular Diastolic Dysfunction in Patients With Chronic Hepatitis C Attaining Sustained Virological Response

BACKGROUND

Pegylated interferon (pegIFN) in combination with ribavirin (RBV) has successfully improved the rate of sustained virological response (SVR) in chronic hepatitis C virus (HCV) infected individuals, which reduces the progression of the chronic liver disease. However, the influence of combination therapy (pegIFN/RBV) on cardiac function has yielded ambiguous results. The present study aimed to evaluate the effects of combination therapy with pegIFN/RBV on cardiac function of HCV-infected individuals with SVR.

MATERIALS AND METHODS

Cardiac function was assessed and correlated in 142 treatment-naïve patients with HCV infections by determining cardiac biomarkers and echocardiography before treatment and for 24 weeks post-treatment.

RESULTS

An SVR was achieved by 50.7% of all patients. Serum N-terminal pro-B-type natriuretic peptide levels were significantly higher in all patients before treatment and decreased significantly 24 weeks post-treatment in the SVR group (62.84 [36.98-102.73] versus 22.87 [15.64-56.92] pg/mL, P < 0.01). Peak early diastolic annular velocity (E') was significantly lower (7.69 ± 2.48 versus 9.74 ± 2.68cm/s, P < 0.001) and E/E' was higher (10.04 ± 2.51 versus 8.18 ± 2.31, P < 0.001) in all patients with SVR. However, there were no statistically significant differences in biomarkers and echocardiographic parameters for patients without SVR. In addition, multivariate analysis identified age (odds ratio [OR] = 1.076; 95% CI: 1.031-1.125; P < 0.001), NT-proBNP (OR = 1.122; 95% CI: 1.002-1.248; P = 0.015), and SVR (OR = 0.532; 95% CI: 0.214-0.895; P = 0.023) as statistically significant independent variables associated with left ventricular diastolic dysfunction.

CONCLUSIONS

The present study showed no adverse effects of combination therapy on cardiac function of HCV-infected individuals with SVR. Subsequent viral eradication resulted in improvement of left ventricular diastolic dysfunction.