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Association between antiviral treatment and extrahepatic outcomes in patients with hepatitis C virus infection
  1. Yao-Chun Hsu1,2,3,4,
  2. Hsiu J Ho5,
  3. Yen-Tsung Huang6,
  4. Hsi-Hao Wang2,
  5. Ming-Shiang Wu7,
  6. Jaw-Town Lin8,9,
  7. Chun-Ying Wu1,5,9,10,11,12
  1. 1Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan
  2. 2Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
  3. 3Center for Database Research, E-Da Hospital, Kaohsiung, Taiwan
  4. 4School of Medicine, I-Shou University, Kaohsiung, Taiwan
  5. 5Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
  6. 6Department of Epidemiology, Brown University, Providence, Rhode Island, USA
  7. 7Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  8. 8School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
  9. 9Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan
  10. 10School of Medicine, National Yang-Ming University, Taipei, Taiwan
  11. 11College of Public Health, China Medical University, Taichung, Taiwan
  12. 12Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan
  1. Correspondence to Professor Chun-Ying Wu, Division of Gastroenterology, Taichung Veterans General Hospital, 1650, Sec. 4, Taiwan Avenue, Taichung 40705, Taiwan; chun{at}


Objective To elucidate the association between antiviral therapy and extrahepatic outcomes in individuals infected with HCV.

Methods This nationwide cohort study screened 293 480 Taiwanese residents with HCV infection and excluded those with substantial comorbidity. A total of 12 384 eligible patients who had received pegylated interferon plus ribavirin between 1 October 2003 and 31 December 2010 were enrolled in the treated cohort; they were matched 1 : 2 with 24 768 untreated controls in the propensity score and post-diagnosis treatment-free period. The incidences of end-stage renal disease (ESRD), acute coronary syndrome (ACS), ischaemic stroke and catastrophic autoimmune diseases were calculated after adjustment for competing mortality.

Results The treated and untreated cohorts were followed up for a mean (±SD) duration of 3.3 (±2.5) and 3.2 (±2.4) years, respectively, until 31 December 2011. The calculated 8-year cumulative incidences of ESRD, ACS, ischaemic stroke and autoimmune catastrophes between treated and untreated patients were 0.15% vs 1.32% (p<0.001), 2.21% vs 2.96% (p=0.027), 1.31% vs 1.76% (p=0.001) and 0.57% vs 0.49% (p=0.816), respectively. Multivariate-adjusted Cox regression revealed that antiviral treatment was associated with lower risks of ESRD (HR 0.15; 95% CI 0.07 to 0.31; p<0.001), ACS (HR 0.77; 95% CI 0.62 to 0.97; p=0.026) and ischaemic stroke (HR 0.62; 95% CI 0.46 to 0.83; p=0.001), but unrelated to autoimmune catastrophes. These favourable associations were invalid in incompletely treated patients with duration <16 weeks.

Conclusions Antiviral treatment for HCV is associated with improved renal and circulatory outcomes, but unrelated to catastrophic autoimmune diseases.


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