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Treatment for Hepatitis C Virus Infection in Adults: Comparative Effectiveness

Slide: 20 of 34

SVR After Antiviral Therapy and Clinical Outcomes in Patients With Chronic HCV Infection

Achieving a sustained virologic response (SVR) after antiviral therapy for chronic hepatitis C virus (HCV) infection appeared to be associated with a lower risk of all-cause mortality when compared with not achieving an SVR. The strength of evidence for this finding was rated moderate.

  • A large Veterans Affairs (VA) cohort study that controlled well for potential confounders found that a sustained virologic response (SVR) after antiviral therapy for chronic hepatitis C virus (HCV) infection was associated with a lower risk of all-cause mortality when compared with no SVR (adjusted hazards ratios [HRs]: 0.71 [0.60–0.86] for HCV genotype 1, 0.62 [0.44–0.87] for HCV genotype 2, and 0.51 [0.35–0.75] for HCV genotype 3).
  • Eighteen other cohort studies found that an SVR was associated with a decreased risk of all-cause mortality, liver-related mortality, hepatocellular carcinoma, and other complications of end-stage liver disease when compared with no SVR, with stronger effect estimates than in the VA study (adjusted HRs generally ranged from around 0.10 to 0.33). However, the studies had methodological shortcomings, including inadequate handling of confounders. Additionally, 10 of the studies were conducted in Asia, limiting applicability for patients in the United States.