Purpose: Sustained virologic response (SVR) is a validated surrogate marker for successful hepatitis C virus (HCV) treatment. Historically, interferon-based therapies, the standard of care for decades, offered only limited efficacy with respect to SVR. The recent introduction of highly effective direct-acting antivirals (DAAs) revolutionised treatment, expanding treatment eligibility among individuals with advanced liver disease (ALD) and drug/alcohol-related substance use disorder. Given these clinical policy shifts, we assessed the real-world impact of SVR on liver-related death for these key clinical groups for whom treatment had previously been less feasible.
Methods: We conducted a population-based, cohort study of Ontario residents with HCV viremia between January 1st, 1999, and December 31st, 2018, with follow-up to May 31st, 2021 (N = 73,411) and used cause-specific hazard models to explore the association between SVR and liver-related death.
Results: SVR was associated with a significant reduction in liver-related deaths (adjusted hazard ratio [aHR]: 0.22, 95%CI: 0.20-0.24). This benefit was consistent across all levels of liver disease severity, including individuals with (aHR: 0.11, 95%CI: 0.06-0.18) and without (aHR: 0.13, 95%CI: 0.10-0.17) cirrhosis, individuals with ALD (aHR: 0.24, 95%CI: 0.22-0.27) as well as among individuals with (aHR: 0.24, 95%CI: 0.21-0.27) and without (aHR: 0.21, 95%CI: 0.18-0.24) substance use disorder.
Conclusions: This study demonstrates the real-world impact of SVR on liver-related mortality and highlights the value of early treatment and continued support for populations who are marginalised.
Copyright: © 2025 Erman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.