Maladies cardiovasculaires et diagnostic

Evaluation of Pulmonary Arterial Hypertension in Patients with Direct-Acting Antiviral Medications for Hepatitis C Virus Infection – A Prospective Observational Cohort Study

Abstract

Schild DP, Roesler G, Hellige GJ, Piso RJ and Arenja N

Background: Chronic hepatitis C Virus (HCV) infected patients are at higher risk for pulmonary arterial hypertension (PAH) due to treatment with interferon (IFN) and ribavirin. The establishment of novel direct-acting antiviral agents (DAA) has revolutionized the HCV therapy. However, hardly any data exist evaluating the evidence of DAA-induced PAH. Therefore, the goal of this study was the evaluation of systolic pulmonary artery pressure (sPAP) in patients undergoing DAA-therapy for chronic HCV infection.

Methods: We prospectively enrolled forty-nine patients at our hospital undergoing 8-12 weeks of DAA-therapy for chronic HCV infection according to HCV genotype and co-medication. A transthoracic echocardiogram (TTE) was performed for assessing sPAP and right ventricular (RV) function before therapy, 8 weeks after DAA-therapy was started and 8 weeks after completion of the total treatment regimen.

Results: Mean patient ’ s age was 51 years and 39% of the population consisted of women. Human immunodeficiency virus (HIV) coinfection was present in 12% of the population. There was no significant difference between sPAP before, during and 8 weeks after treatment (26.4 ± 6.6 mmHg, 27.6 ± 6.4 mmHg respectively 28.4 ± 5.4 mmHg, p= 0.32). The results were sex-independent in subgroup analysis. In addition, the RV function before and after treatment was normal without significant differences (fractional area change (FAC) 50.4 ± 7.3% before, 51.9 ± 6% during and 50.2 ± 7.3% after treatment, p=0.9).

Conclusion: DAA-therapy for chronic HCV infection is not associated with PAH or RV dysfunction in a follow-up of 16-20 weeks.