Sustained Virologic Response Reduces Risk for Extrahepatic Complications From HCV, Notably in Women

Hepatitis C virus, computer illustration. Hepatitis C is an RNA (ribonucleic acid) virus from the Flaviviridae family. It is transmitted by blood, sexual intercourse, and across the placenta. It infects liver cells causing an inflammatory disease that can lead to degeneration and scarring (cirrhosis).
A team of investigators examined differences in outcomes according to sex in risk for acute coronary syndrome, end-stage renal disease, and ischemic stroke by treatment and response in a large US-based multisite cohort of patients with hepatitis C virus infection.

A sustained virologic response (SVR) reduces the risk for extrahepatic complications from hepatitis C virus (HCV) infection, especially in women, according to study results published in the American Journal of Gastroenterology.

Although rates of cardiovascular and renal disease differ between men and women, the differences in the effects of antiviral treatment for HCV according to sex have not been investigated. Therefore, researchers examined sex differences in the risk for acute coronary syndrome (ACS), end-stage renal disease (ESRD), and ischemic stroke by treatment and response in a large US-based multisite cohort of 15,295 patients with HCV, approximately 40% of whom were women.

After controlling for other risk factors, SVR (following treatment with interferon [IFN] or direct-acting antiviral agents) was found to significantly reduce the risk for all outcomes, particularly among women. Female patients who achieved SVR after IFN-based treatment had a significantly lower risk for ACS compared with male patients with SVR from either treatment type. Successful treatment seemed to be most protective against ESRD; female patients who achieved SVR were at a 66% to 68% lower risk than untreated patients whereas men were at a 38% to 42% lower risk. Interferon treatment failure significantly increased the risk for all outcomes by 50% to 100% among female patients. Compared with no treatment, female patients who experienced IFN treatment failure were at a 63% increased risk for ACS, almost twice the risk for ESRD, and a 51% increased risk for stroke.

The authors concluded, “We found that women particularly benefited from successful treatment regarding reduced risk for ACS, ESRD, and ischemic stroke compared with patients who did not receive treatment or those who experienced [treatment failure].”

They added, “On the other hand, women who experienced failure of IFN treatment were at higher risk of all outcomes compared with untreated patients.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Li J, Gordon SC, Zhou Y, et al. Sex differences in extrahepatic outcomes after antiviral treatment for hepatitis C. Am J Gastroenterol. Published online December 24, 2020.  doi: 10.14309/ajg.0000000000001095