Sustained Virological Response After Direct-Acting Antiviral Therapy in Hepatitis C Virus-Infected Individuals With and Without Decompensated Liver Cirrhosis: A One-Year Follow-Up Study

TL;DR

This study shows that direct-acting antiviral therapy effectively clears hepatitis C virus in patients with and without severe liver disease, though some patients with severe cirrhosis die during treatment.

Contribution

The study compares sustained virological response rates and mortality in hepatitis C patients with and without decompensated cirrhosis over one year of DAA therapy.

Findings

DAA therapy achieved 100% SVR in CLD patients and 97.9% in DCLD patients after one year.

DCLD patients had a 10% mortality rate, unrelated to viral load but linked to liver function and disease severity.

All surviving DCLD patients maintained undetectable viral load at one year.

Abstract

Introduction

Hepatitis C is a significant global health concern, causing many deaths. In the National Viral Hepatitis Control Program (NVHCP), direct-acting antiviral (DAA) therapy (sofosbuvir and velpatasvir, without ribavirin) is used to achieve sustained virological response (SVR) in hepatitis C virus (HCV)-infected individuals. The duration is longer for decompensated liver cirrhosis disease (DCLD) patients (24 weeks) compared to compensated liver cirrhosis disease (CLD) patients (12 weeks). The present study was planned to assess SVR in patients with HCV infection, both with CLD and DCLD, at 12 weeks, 6 months, and 1 year after treatment initiation.

Methods

This pilot study enrolled 100 treatment-naïve chronic hepatitis C patients, with 50 having CLD and 50 having DCLD. Serum samples were collected from these patients before treatment initiation, and follow-up samples were collected at 12 weeks, 6 months, and 1 year after initiation of treatment to monitor SVR in both groups by real-time polymerase chain reaction (PCR).

Results

Among 50 DCLD patients, three died within the first three months of treatment. The remaining 47 achieved an undetectable viral load at 12 weeks (100%). By six months, two more patients had died, and one experienced viral relapse, resulting in a 97.9% SVR. However, by one year, all surviving patients had no detectable viral load. The DCLD group had a 10% mortality rate (5/50), including three deaths within 12 weeks (one from variceal bleeding and two from non-liver-related causes), and two post-treatment despite achieving SVR. Mortality was not linked to viral load, suggesting that liver function and disease severity play a more significant role in patient outcomes. All CLD patients achieved SVR at 12 weeks after initiation of therapy (100%), which persisted at six months and one-year follow-up.

Conclusion

DAA therapy is highly effective, achieving a 100% SVR rate and sustained liver function improvement in HCV-infected patients with liver disease.