S. VAN HEES (1), P. MICHIELSEN (1), L. VONGHIA (1), S. FRANCQUE (1), T. VANWOLLEGHEM (1) / [1] Antwerp University Hospital, Edegem, Belgium, Department of Gastroenterology and Hepatology
Introduction: With the recent introduction of direct acting antivirals (DAA), eradication of the Hepatitis C Virus (HCV) has become possible in almost all patients. The effect of DAA’s on liver-related manifestations of HCV has been extensively studied, but their effect on extrahepatic manifestations remains unknown.
Aim: We studied the effect of DAA on extrahepatic manifestations of the Hepatitis C Virus.
Methods: This is a retrospective analysis of all DAA treated patients from the Antwerp University Hospital showing extrahepatic manifestations of HCV. Patients were included if they showed extrahepatic manifestations at the time of DAA treatment start. Wilcoxon-rank and chi-square tests were used to test for associations between treatment-related factors and clinical disease improvement of HCV extrahepatic manifestations.
Results: A total of 10 patients were included. They showed either non-Hodgkin B-cell lymphoma (NHL) (n=4), cryoglobulinemia/vasculitis/neuropathy (n=1), arthritis (n=2), or cryoglobuline-associated nephropathy (n=3). Patients were treated with sofosbuvir-daclatasvir±ribavirine (n=5), simeprevir-sofosbuvir (n=1), ledipasvir-sofosbuvir (n=1) or Peg-interferon-Ribavirine combined with either sofosbuvir (n=2) or simeprevir (n=1). All patients achieved an end-of-treatment response. Four patients had genotype 1a, two genotype 1b, one genotype 2, three genotype 3. Following end-of-treatment response, partial or complete clinical remission of NHL was observed, whereas no clinical improvement was observed in case of vasculitis/neuropathy or nephropathy. Cryoglobulins disappeared from the blood after HCV treatment. Signs of arthritis improved slightly in 1/2 patient. Wilcoxon signed ranks test confirmed that overall end-of-treatment response was not associated with clinical disease improvement (p=0.739). Chi-square test revealed that clinical disease improvement upon end-of-treatment response significantly depended on the type of extrahepatic manifestation (p=0.030). There was no association between HCV genotype and clinical improvement of extrahepatic manifestations after treatment stop (chi-square: p=0.267).
Conclusions: Clinical improvement of HCV-related extrahepatic manifestations after DAA treatment largely depends upon the type of manifestation. Remission was observed in case of HCV-associated NHL and cryoglobulinemia, but not in case of neuro- and nephropathy.