Direct-Acting Antivirals and Risk of Hepatitis C Extrahepatic Manifestations
Notice bibliographique
Résumé
Importance: Hepatitis C virus (HCV) infection is associated with various extrahepatic manifestations (EHMs) that can significantly impact patients' quality of life and overall health outcomes. Objective: To assess the association between successful direct-acting antiviral (DAA) treatment and the risk of EHMs in individuals with chronic HCV infection. Design, Setting, and Participants: This population-based retrospective cohort study used data from 1990 to 2021, with a median follow-up of 2.5 years for outcome assessment. People treated with DAAs were matched to those who were never treated by year of HCV diagnosis and inverse probability of treatment weights (IPTW) were estimated to adjust for differences in baseline characteristics between treated and untreated people. The study took place in British Columbia, Canada, using the BC Hepatitis Testers Cohort, which includes more than 1 300 000 people tested for HCV between 1990 to 2015. Data were analyzed from February 2024 to March 2025. Exposure: Successful HCV treatment with DAAs, defined as achieving sustained virologic response (SVR). Main Outcomes and Measures: Incidence of 5 groups of EHMs: chronic kidney disease and end-stage kidney disease (CKD and ESKD), type 2 diabetes (T2D), stroke, major adverse cardiac events (MACE), and neurocognitive disorders (NCD). Results: Of 22 576 individuals included in this study (mean [SD] age at HCV diagnosis, 42.0 [12.0] years; 14 950 male [66.2%]), 11 953 received DAA treatment and achieved SVR, 386 received treatment but did not achieve SVR, and 10 237 never received treatment. The incidence rates (per 1000 person-years) in untreated vs treated with SVR groups were: 21.0 (95% CI, 19.0-23.1) vs 14.7 (95% CI, 13.4-16.1) for CKD and ESKD, 8.9 (95% CI, 7.7-10.2) vs 6.3 (95% CI, 5.5-7.2) for stroke, 26.7 (95% CI, 24.5- 29.1) vs 19.3 (95% CI, 17.8-20.9) for MACE, 19.2 (95% CI, 17.3-21.2) vs 10.3 (95% CI, 9.2-11.5) for NCD, and 6.4 (95% CI, 5.4-7.7) vs 9.2 (95% CI, 8.1-10.4) for T2D. In multivariable IPTW-weighted regression models, successful DAA treatment was associated with lower risk of CKD and ESKD (adjusted cause-specific hazard ratio [acsHR], 0.54; 95% CI, 0.47-0.63), stroke (acsHR, 0.66; 95% CI, 0.54-0.81), MACE (acsHR, 0.58; 95% CI, 0.52-0.66), and NCD (acsHR, 0.52; 95% CI, 0.45-0.61) compared with no treatment. However, no significant association was found for T2D (acsHR, 1.04; 95% CI, 0.84-1.29). Conclusions and Relevance: In this cohort study of 22 576 individuals with chronic HCV infection, successful HCV treatment with DAAs was associated with lower risk of several EHMs. These findings highlight the importance of early HCV screening and treatment to prevent EHMs and improve overall health outcomes.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».