TY - JOUR
T1 - Liver-related complications before and after successful treatment of chronic hepatitis C virus infection in people with inherited bleeding disorders
AU - Isfordink, Cas J.
AU - van Erpecum, Karel J.
AU - Fischer, Kathelijn
AU - van der Valk, Paul R.
AU - van Vulpen, Lize F. D.
AU - Schutgens, Roger E. G.
AU - Arends, Joop E.
AU - Mauser-Bunschoten, Evelien P.
N1 - Funding Information: C.J. Isfordink has received research funding from Gilead, not related to this study. K.J. van Erpecum participated in advisory boards of Gilead, Janssen‐Cilag, BMS, Abbvie, and MSD and received research grants from Gilead, Janssen‐Cilag and the Dutch Cancer Society (KWF Kankerbestrijding). The Van Creveldkliniek has received speaker's fees from Bayer, Baxter/Shire, SOBI/Biogen, CSL Behring and NovoNordisk; consultancy fees from Bayer, Biogen, CSL‐Behring, Freeline, NovoNordisk, Roche and SOBI; and research support from Bayer, Baxter/Shire, Novo Nordisk, Pfizer and Biogen for the work done by K. Fischer. P.R. van der Valk had received an research grant from Baxalta. L.F.D. van Vulpen has received research grants from CSL Behring and Griffols and is consultant for Sobi and Tremeau (funds to the institute). R.E.G. Schutgens has received research support from Bayer, Baxalta, CSL Behring, Novo Nordisk, Pfizer, Sobi, and Sanquin. J.E. Arends reports fees paid to the institution from Gilead, Janssen‐Cilag, Abbvie and MSD for advisory membership, all outside the submitted work. All other authors report no conflict of interest. Publisher Copyright: © 2022 The Authors. Haemophilia published by John Wiley & Sons Ltd.
PY - 2023/1
Y1 - 2023/1
N2 - Introduction: With availability of direct-acting antivirals (DAA), most persons with inherited bleeding disorders are currently cured of hepatitis C virus (HCV) infection. The risk of liver-related complications following HCV cure has not been reported for this population. Aim: Reporting liver-related complications during long-term chronic HCV infection and following sustained virological response (SVR) in this population. Methods: Retrospective follow-up of a prospective single-centre cohort of HCV antibody-positive persons with inherited bleeding disorders. Primary endpoint was liver-related complications [hepatocellular carcinoma (HCC), decompensated cirrhosis, bleeding gastroesophageal varices]. Liver-related complications were reported separately during chronic HCV and following SVR, stratified for interferon-based and DAA-based SVR. Results: In total 309/381 (81%) HCV antibody-positive individuals developed chronic HCV infection. Median follow-up was 44 years [interquartile range (IQR): 34–50]. Liver-related complications occurred in 36/309 (12%) of individuals with chronic HCV infection after median 31 years of chronic infection. Of 199 individuals with SVR, 97 were cured with interferon-based regimens and 102 with DAA after median infection durations of 29 and 45 years, respectively. At end of follow-up, respectively, 21% and 42% had advanced fibrosis or cirrhosis. Post-SVR, seven (4%) individuals had a liver-related complication, mainly HCC (n = 4). Incidence of liver-related complications per 100 patient-years post-SVR follow-up was.2 for interferon-cured and 1.0 for DAA-cured individuals (p =.01). Conclusion: Successful HCV treatment does not eliminate the risk of liver-related complications in persons with inherited bleeding disorders. Due to higher baseline risk, incidence was higher after DAA than interferon-based SVR. We advise continuing HCC surveillance post-SVR in all with advanced fibrosis or cirrhosis.
AB - Introduction: With availability of direct-acting antivirals (DAA), most persons with inherited bleeding disorders are currently cured of hepatitis C virus (HCV) infection. The risk of liver-related complications following HCV cure has not been reported for this population. Aim: Reporting liver-related complications during long-term chronic HCV infection and following sustained virological response (SVR) in this population. Methods: Retrospective follow-up of a prospective single-centre cohort of HCV antibody-positive persons with inherited bleeding disorders. Primary endpoint was liver-related complications [hepatocellular carcinoma (HCC), decompensated cirrhosis, bleeding gastroesophageal varices]. Liver-related complications were reported separately during chronic HCV and following SVR, stratified for interferon-based and DAA-based SVR. Results: In total 309/381 (81%) HCV antibody-positive individuals developed chronic HCV infection. Median follow-up was 44 years [interquartile range (IQR): 34–50]. Liver-related complications occurred in 36/309 (12%) of individuals with chronic HCV infection after median 31 years of chronic infection. Of 199 individuals with SVR, 97 were cured with interferon-based regimens and 102 with DAA after median infection durations of 29 and 45 years, respectively. At end of follow-up, respectively, 21% and 42% had advanced fibrosis or cirrhosis. Post-SVR, seven (4%) individuals had a liver-related complication, mainly HCC (n = 4). Incidence of liver-related complications per 100 patient-years post-SVR follow-up was.2 for interferon-cured and 1.0 for DAA-cured individuals (p =.01). Conclusion: Successful HCV treatment does not eliminate the risk of liver-related complications in persons with inherited bleeding disorders. Due to higher baseline risk, incidence was higher after DAA than interferon-based SVR. We advise continuing HCC surveillance post-SVR in all with advanced fibrosis or cirrhosis.
KW - antiviral agents
KW - cirrhosis
KW - haemophilia
KW - hepatocellular carcinoma
KW - viral hepatitis
UR - http://www.scopus.com/inward/record.url?scp=85139069548&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/hae.14668
DO - https://doi.org/10.1111/hae.14668
M3 - Article
C2 - 36184751
SN - 1351-8216
VL - 29
SP - 106
EP - 114
JO - Haemophilia
JF - Haemophilia
IS - 1
ER -