Direct-Acting Antivirals Reduce Extrahepatic Risks in HCV Patients

In a groundbreaking study, researchers have demonstrated that successful treatment of hepatitis C virus (HCV) with direct-acting antivirals (DAAs) significantly decreases the risk of various extrahepatic manifestations (EHMs), including chronic kidney disease (CKD), stroke, major adverse cardiac events (MACE), and neurocognitive disorders. The findings, published in the Journal of the American Medical Association Network Open on June 12, 2025, highlight the broader health implications of effective HCV management.

HCV affects approximately 50 million people globally, with around 1 million new infections reported annually, according to the World Health Organization (WHO) (World Health Organization, 2024). Although there is no effective vaccine, DAAs have been shown to achieve a cure in over 95% of cases. The study, which utilized data from the BC Hepatitis Testers Cohort, focused on individuals diagnosed with chronic HCV and analyzed the health outcomes associated with DAA treatment.

Naveed Zafar Janjua, MBBS, DrPH, an executive director at the BC Centre for Disease Control and clinical associate professor at the University of British Columbia, emphasized the importance of understanding the protective effects of DAAs. 'To advance our understanding of the protective effects of DAAs against extrahepatic manifestations, it is critical to assess diverse EHMs, particularly within large, population-based cohorts,' he stated (Janjua et al., 2025).

The study involved over 22,000 individuals, with a matched cohort of those treated with DAAs and those who were untreated. Researchers classified EHMs into five categories: CKD/ESKD, type 2 diabetes, hospitalized stroke, MACE, and neurocognitive disorders. The results indicated that individuals who achieved sustained virologic response (SVR) after DAA treatment had significantly lower rates of CKD/ESKD, stroke, MACE, and neurocognitive disorders compared to the untreated group.

Specifically, the incidence rates per 1,000 person-years for CKD/ESKD were 21.0 in untreated individuals versus 14.7 in those treated and achieving SVR. Stroke incidence was 8.9 versus 6.3, and MACE was 26.7 for the untreated group compared to 19.3 for those with SVR (Janjua et al., 2025). However, type 2 diabetes risk did not show a significant decrease following DAA treatment.

The implications of these findings are significant, as they suggest that effective HCV treatment can lead to improved overall health outcomes beyond liver-related issues. 'The potential extrahepatic benefits of HCV treatment highlighted in this study provide additional rationale for enhanced efforts to identify and overcome barriers to care, including reducing stigma and increasing clinician awareness,' the researchers concluded.

This study aligns with a growing body of literature suggesting that addressing HCV not only alleviates liver disease but also mitigates other serious health risks. As healthcare providers and policymakers seek to improve HCV treatment access, understanding the full spectrum of benefits associated with DAAs is crucial for public health strategies aimed at combating this global health issue.

For further insights and ongoing updates on HCV treatment developments, healthcare professionals are encouraged to engage with educational resources and subscribe to relevant medical journals and updates.