Direct-acting Antiviral Therapy for HCV Infection is Associated with a Reduced Risk of Cardiovascular Disease Events.

BACKGROUND & AIMS: Infection with hepatitis virus C (HCV) is associated with an increased risk of cardiovascular disease (CVD) events. It is not clear whether treatment with direct-acting antiviral (DAA) agents affects risk of CVD.

METHODS: We searched the Electronically Retrieved Cohort of HCV-infected Veterans database for patients with chronic HCV infection (n=242,680), identifying patients who had been treated with a pegylated interferon and ribavirin regimen (n=4436) or a DAA-containing regimen (12,667). Treated patients were matched for age, race, sex, and baseline values with patients who had never received treatment for HCV infection (controls). All subjects were free of any CVD event diagnosis of HCV infection at baseline. The primary outcome was incident CVD events, identified by ICD9/10 code, in the different groups and among patients with vs without a sustained virologic response (SVR) to therapy.

RESULTS: There were 1239 (7.2%) incident CVD events in the treated and 2361 (13.8%) in the control group. The incidence rate was 30.9/1000 patient-years (95% CI, 29.6-32.1) in the control group and 20.3/1000 patient-years (95% CI, 19.2-21.5) in the treated groups (P<.0001). Treatment with pegylated interferon and ribavirin (hazard ratio, 0.78; 95% CI, 0.71-0.85) or a DAA regimen (0.57; 95% CI, 0.51-0.65) was associated with a significantly lower risk of a CVD event, compared with no treatment (controls). Incidence rates for CVD events were 23.5/1000 patient-years (95% CI, 21.8-25.3) in group treated with pegylated interferon and ribavirin regimen, 16.3/1000 patient-years (95% CI, 14.7-18.0) in the group treated with a DAA regimen, and 30.4 (95%, 29.2-31.7) in the control group. An SVR was associated with a lower risk of incident CVD events (hazard ratio, 0.87; 95% CI, 0.77-0.98).

CONCLUSIONS: In an analysis of a cohort of HCV-infected Veterans, we found treatment of HCV infection to be associated with a significant reduction in risk of CVD events. Patients treated with a DAA regimen and patients who achieved SVRs had the lowest risk for CVD events.