This study provides evidence that using DAAs reduces liver fibrosis and improves clinical outcomes.
The impact of direct-acting antivirals (DAAs) on hepatitis C virus (HCV) infection has been a topic of debate. A recent study from Korea University has demonstrated that DAAs significantly improve clinical outcomes for patients with chronic HCV infection. The research indicates that DAAs improve liver health and reduce liver fibrosis, thereby lowering the overall disease burden and extending life expectancy.1
Published in eClinicalMedicine, the study aimed to assess how DAA treatment affects disease burden in HCV-infected patients. By analyzing individual participant data, researchers found that DAA treatment was associated with notable improvements in liver health and a reduction in liver fibrosis-related issues.2
The study analyzed data from 11,725 HCV-infected patients between January 1, 2007, and February 17, 2022. Of these, 8,464 patients (72%) received DAA treatment. The treatment led to significant improvements in liver fibrosis indicators: APRI (from 0.64 to 0.33, p < .0001), FIB-4 (from 2.42 to 1.93, p < .0001), and liver stiffness (from 7.4 kPa to 6.2 kPa, p < .0001).2
Seungbong Han, PhD, MS says, “For individuals, early detection and effective treatment would mean fewer complications, better health outcomes, and enhanced quality of life. Successful strategies could serve as models for other countries with high Hepatitis C prevalence, leading to global improvement in Hepatitis C management.”1
During a median follow-up of 27.5 months, 4% of patients died, 5% developed HCC, and 4.9% had decompensation. The DAA-treated group had significantly lower APRI-based DALY estimates (4.55 years vs. 5.14 years, p < .0001) and FIB-4-based DALY estimates (5.43 years vs. 5.79 years, p < .0001) compared to the untreated group. These benefits were most pronounced in patients aged 40–60 years.2
“The risk of liver-related events increased with increasing fibrosis stage in both groups. It is well known that clearing HCV infection can reduce the fibrotic burden and improve long-term outcomes in patients with CHC. Based on this information, we incorporated the change in fibrotic burden after DAA treatment into the DALY analysis using noninvasive fibrosis surrogate measures. Indeed, an improvement in fibrotic burden was observed through noninvasive surrogate measures of fibrosis, leading to an improvement in disease burden in our current study,” according to the investigators.2
Conducted as a nationwide multicenter retrospective cohort study across 29 tertiary institutions in South Korea, the research utilized medical records to measure disease burden using disability-adjusted life years (DALYs) and assessed fibrosis through APRI, FIB-4 index, and transient elastography (TE).2
It included untreated and DAA-treated patients, excluding those with prior interferon-based treatments. Clinical outcomes such as hepatocellular carcinoma (HCC), decompensation, and mortality were also assessed.2
Multivariable analyses revealed that DAA treatment reduced the risk of HCC, decompensation, and mortality compared to no treatment (hazard ratios: .41, .31, and .22, respectively; p < .0001).2
The study has limitations including reliance on biomarkers and transient elastography (TE) with data available for only 50% of patients and no histological confirmation; potential biases from its retrospective design; variable follow-up durations; exclusion of prior interferon patients affecting generalizability; incomplete mortality data from hospital records; and possible inaccuracies in noninvasive fibrosis tests and ultrasound. Additionally, the absolute difference in DALYs between groups, though statistically significant, was small.1
Further research, including studies utilizing liver biopsies, is needed to better understand how DAA treatment impacts fibrosis-based disease burden beyond what noninvasive tests can reveal. “Our study can help improve public health, healthcare systems, and individual lives by encouraging the development of early intervention and effective treatment strategies for HCV infection,” concludes Han.1
