Daily Dose: Universal DAA Therapy for all Persons with HCV

January 9, 2023

Sydney Jennings

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On January 6, 2023, we reported on a study published in the JAMA Internal Medicine that investigated and compared the risk of liver-related and nonliver complications as well as overall mortality between direct-acting antiviral (DAA)-treated and untreated patients with chronic hepatitis C (CHC).

The study

A total of 245 596 insured patients (mean age, 58.7 years; 41% women) with CHC were included in the study, of whom 40 654 received ≥1 prescriptions for DAAs (without interferon) and 204 942 were untreated. The main outcomes and measures were incidence (per 1000 person-years) of hepatocellular carcinoma (HCC), liver decompensation, relevant nonliver events (nonliver cancer, diabetes, chronic kidney disease [CKD], cardiovascular disease), and overall mortality.

Compared to untreated patients, DAA-treated participants had lower incidence of liver-related outcomes, such as decompensation and HCC in compensated cirrhosis, and nonliver outcomes such as diabetes and CKD. The all-cause mortality rates per 1000 person-years were significantly lower in DAA-treated participants compared with untreated patients

Clinical implications

"The study findings also highlight a substantial need to provide DAA therapy to all patients with HCV, regardless of disease stage or financial status. Additional national efforts are needed to reach and treat US population groups that are underinsured or not insured, incarcerated, and otherwise marginalized, such as users of illicit drugs, who are also at higher risk of disease complication and reinfection. Our findings advocate for continued efforts to promote hepatitis C screening and early diagnosis and treatment—prior to the onset of CHC complications—to prevent liver and nonliver morbidity and mortality."

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