- B.C. researchers reviewed health indicators of more than 22,000 people who had hepatitis C
- Those treated and cured had a lower risk of kidney, heart, stroke and neurocognitive issues
- The findings demonstrate the broader health benefits of hepatitis C treatment beyond the liver
Hepatitis C virus (HCV) infects the liver and causes inflammation in this vital organ. As chronic HCV infection sets in, healthy liver tissue is gradually replaced with scar tissue. Over time, the liver becomes increasingly dysfunctional, and a variety of problems ensue. Some people develop persistent fatigue. Later, they can develop internal bleeding, fluid buildup in the abdomen and serious abdominal infections. Eventually, difficulty thinking clearly and problems with memory occur. As the liver becomes increasingly unable to filter the blood of waste products, the skin gradually turns yellow (jaundice). The risk of liver cancer increases as the amount of scar tissue expands. If HCV is left undiagnosed and untreated, it can result in death.
HCV can be detected with blood tests. Furthermore, the health of the liver can be assessed with additional blood tests and a specialized ultrasound scan called Fibroscan.
Several powerful HCV treatments are available in pill form. These are called direct-acting antivirals (DAAs) and can be taken once daily. Two commonly used HCV treatments are as follows:
- Epclusa – a pill containing sofosbuvir + velpatasvir
- Maviret – a pill containing glecaprevir + pibrentasvir
These drugs are associated with high rates of cure (95%) after a course of treatment (usually eight to 12 weeks, depending on the pill used). They are generally safe and well tolerated.
In Canada, DAAs first became available in 2014, with restrictions on who could access them through public subsidies. By 2018, these restrictions were lifted.
Outside the liver
As mentioned earlier, chronic HCV infection can cause a range of problems, particularly inside the liver. While HCV treatment can help the liver begin the healing process, researchers also know that HCV-related inflammation and injury can occur outside the liver. Such complications can include the following:
- neurological issues – difficulty thinking clearly and problems with memory; in severe cases, the risk of dementia increases
- kidney issues – chronic kidney disease and end-stage kidney disease
- major cardiovascular events – heart attack, heart failure, and the need for interventions such as coronary bypass surgery
- stroke
- type 2 diabetes
In Vancouver
A team of researchers at the British Columbia Centre for Disease Control (BCCDC), the University of British Columbia and St. Paul’s Hospital in Vancouver cooperated and reviewed anonymized health-related information collected in databases. They focused on the years 1990 to 2021. All participants had HCV and, on average, were in the study for three years.
Researchers compared information collected from people who were treated with DAAs and those who were not. They analysed data from 22,576 people with chronic HCV, diagnosed on average at age 42. About 66% were assigned male at birth and 34% were assigned female at birth.
Prior to treatment, the most common HCV-related problems that occurred outside of the liver were as follows (in descending order):
- type 2 diabetes
- major cardiovascular events
- kidney issues
- neurocognitive issues
- stroke
Researchers considered many factors with the potential to affect their analysis, including sex, age, ethno-racial group, income, coinfection with hepatitis B virus and HIV, high blood pressure, obesity, severe mental illness, substance use, and so on.
Results
Nearly 12,000 people (11,953) took DAAs and were cured. A total of 386 who took DAAs were not cured.
Statistical analysis found that people who took DAAs and who were cured subsequently had a reduced risk of developing the following:
- kidney issues
- stroke
- major cardiovascular events
- neurocognitive disease
However, there was no decrease in the risk of developing type 2 diabetes.
Other studies have found broadly similar benefits from HCV treatment after people were cured.
Why not type 2 diabetes?
The researchers are uncertain as to why there was no reduced risk for subsequently developing type 2 diabetes after being cured of HCV. They noted that it is possible that people who were cured had better “quality of access to ongoing healthcare and screening, leading to a higher frequency of being diagnosed with type 2 diabetes, compared with those who were never treated for HCV.”
Other studies have found that some people gain weight after being cured of HCV, and this excess weight may increase their risk of diabetes.
Bear in mind
The B.C. study was large and had comprehensive health-related information on many people. The overall results from the study underscore the many benefits of HCV treatment. It should encourage health systems and clinics to offer HCV screening and early initiation of treatment to cure people so that the spread of HCV can be reduced and overall health improved.
—Sean R. Hosein
Resources
Hepatitis C Treatment – Self-directed course
Hepatitis C Key Messages - Treatment – CATIE
REFERENCE:
Jeong D, Wong S, Karim ME, et al. Direct-acting antivirals and risk of hepatitis C extrahepatic manifestations. JAMA Network Open. 2025 Jun 2;8(6):e2514631.