Background and aim Chronic HCV infection is associated with several extrahepatic manifestations (EHMs). Data on the effect of sustained virological response (SVR) on the risk of EHMs are limited. Methods We conducted a retrospective cohort study using data of patients from the US Veterans Affairs HCV Clinical Case Registry who had a positive HCV RNA test (10/1999-08/2009). Patients receiving interferon-based antiviral therapy (AVT) were identified. SVR was defined as negative HCV RNA at least 12 weeks after end of AVT. Risks of eight incident EHMs were evaluated in Cox regression models. Results Of the 160 875 HCV-infected veterans, 31 143 (19.4%) received AVT, of whom 10 575 (33.9%) experienced SVR. EHM risk was reduced in the SVR group compared with untreated patients for mixed cryoglobulinaemia (adjusted HR (aHR)=0.61; 95% CI 0.39 to 0.94), glomerulonephritis (aHR=0.62; 95% CI 0.48 to 0.79), porphyria cutanea tarda (PCT) (aHR=0.41; 95% CI 0.20 to 0.83), non-Hodgkin’s lymphoma (NHL) (aHR=0.64; 95% CI 0.43 to 0.95), diabetes (aHR=0.82; 95% CI 0.76 to 0.88) and stroke (aHR=0.84; 95% CI 0.74 to 0.94), but not for lichen planus (aHR=1.11; 95% CI 0.78 to 1.56) or coronary heart disease (aHR=1.12; 95% CI 0.81 to 1.56). Risk reductions were also observed when patients with SVR were compared with treated patients without SVR for mixed cryoglobulinaemia, glomerulonephritis, PCT and diabetes. Significant reductions in the magnitude of aHRs towards the null with increasing time to initiation of AVT after HCV diagnosis were observed for glomerulonephritis, NHL and stroke. Conclusions Risks of several EHMs of HCV infection are reduced after AVT with SVR. However, early initiation of AVT may be required to reduce the risk of glomerulonephritis, NHL and stroke.

中文翻译：

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持续病毒学应答对丙型肝炎病毒感染肝外表现风险的影响

背景和目的 慢性 HCV 感染与多种肝外表现 (EHM) 相关。关于持续病毒学应答 (SVR) 对 EHM 风险影响的数据有限。方法 我们使用来自美国退伍军人事务部 HCV 临床病例登记处的 HCV RNA 检测呈阳性 (10/1999-08/2009) 患者的数据进行了一项回顾性队列研究。确定接受基于干扰素的抗病毒治疗 (AVT) 的患者。SVR 定义为 AVT 结束后至少 12 周 HCV RNA 阴性。在 Cox 回归模型中评估了八个事件 EHM 的风险。结果 在 160 875 名感染 HCV 的退伍军人中，31 143 名（19.4%）接受了 AVT，其中 10 575 名（33.9%）经历了 SVR。与未经治疗的混合型冷球蛋白血症患者相比，SVR 组的 EHM 风险降低（调整后的 HR (aHR)=0.61；95% CI 0.39 至 0.94），肾小球肾炎（aHR=0.62；95% CI 0.48 至 0.79），迟发性皮肤卟啉症（PCT）（aHR=0.41；95% CI 0.20 至 0.83），非霍奇金淋巴瘤（NHL）（aHR=0.64 至 CI 0.043；0.043） 0.95）、糖尿病（aHR=0.82；95% CI 0.76 至 0.88）和中风（aHR=0.84；95% CI 0.74 至 0.94），但不适用于扁平苔藓（aHR=1.11；95% CI 0.78 至 1.56）心脏病（aHR=1.12；95% CI 0.81 至 1.56）。在混合冷球蛋白血症、肾小球肾炎、PCT 和糖尿病方面，当将 SVR 患者与未接受 SVR 的治疗患者进行比较时，也观察到风险降低。对于肾小球肾炎、NHL 和中风，随着 HCV 诊断后开始 AVT 的时间的增加，aHR 的幅度显着降低至零。结论 使用 SVR 进行 AVT 后，HCV 感染的几种 EHM 的风险降低。然而，