BACKGROUND AND AIMS Recent studies suggest an association between hepatitis C virus (HCV) infection and cardiovascular damage, including carotid atherosclerosis, with a possible effect of HCV clearance on cardiovascular outcomes. We aimed to examine whether HCV eradication by direct-acting antiviral agents (DAA) improves carotid atherosclerosis in HCV-infected patients with advanced fibrosis/compensated cirrhosis. MATERIALS AND METHODS One hundred eighty-two consecutive patients with HCV and advanced fibrosis or compensated cirrhosis were evaluated. All patients underwent DAA-based antiviral therapy according to AISF/EASL guidelines. Intima-media thickness (IMT), carotid thickening (IMT ≥1 mm) and carotid plaques, defined as focal thickening of ≥1.5 mm at the level of the common carotid, were evaluated by ultrasonography (US) at baseline and 9-12 months after the end of therapy. Fifty-six percent of patients were male, mean age 63.1 ± 10.4 years, and 65.9% had compensated cirrhosis. One in five had diabetes, 14.3% were obese, 41.8% had arterial hypertension and 35.2% were smokers. At baseline, mean IMT was 0.94 ± 0.29 mm, 42.8% had IMT ≥1 mm, and 42.8% had carotid plaques. RESULTS All patients achieved a 12-week sustained virological response. IMT significantly decreased from baseline to follow-up (0.94 ± 0.29 mm vs. 0.81 ± 0.27, p <0.001). Consistently, a significant reduction in the prevalence of patients with carotid thickening from baseline to follow-up was observed (42.8% vs. 17%, p <0.001), while no changes were reported for carotid plaques (42.8% vs. 47.8%, p = 0.34). These results were confirmed in subgroups of patients stratified for cardiovascular risk factors and liver disease severity. CONCLUSION HCV eradication by DAA improves carotid atherosclerosis in patients with severe fibrosis with or without additional metabolic risk factors. The impact of this improvement in the atherosclerotic burden in terms of reduction of major cardiovascular outcomes is worth investigating in the long term. LAY SUMMARY Hepatitis C virus eradication by direct-acting antiviral agents improves carotid atherosclerosis in patients with advanced fibrosis/compensated cirrhosis. The improvement in intima-media thickness and carotid thickening was confirmed after stratification for severity of liver disease and cardiovascular risk factors. Hepatitis C virus eradication by direct-acting antiviral agents also lead to improvement in glucose homeostasis and increased cholesterol levels.

中文翻译：

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直接抗病毒药物根除丙型肝炎病毒可改善严重肝纤维化患者的颈动脉粥样硬化

背景和目的 最近的研究表明，丙型肝炎病毒 (HCV) 感染与心血管损伤（包括颈动脉粥样硬化）之间存在关联，HCV 清除可能对心血管结局产生影响。我们旨在检查通过直接作用抗病毒药物 (DAA) 根除 HCV 是否能改善患有晚期纤维化/代偿性肝硬化的 HCV 感染患者的颈动脉粥样硬化。材料和方法 对 182 名 HCV 和晚期纤维化或代偿性肝硬化的连续患者进行了评估。根据 AISF/EASL 指南，所有患者均接受了基于 DAA 的抗病毒治疗。内中膜厚度 (IMT)、颈动脉增厚 (IMT ≥1 mm) 和颈动脉斑块，定义为颈总动脉水平局灶性增厚≥1.5 mm，在基线和治疗结束后 9-12 个月通过超声检查 (US) 进行评估。56% 的患者为男性，平均年龄 63.1 ± 10.4 岁，65.9% 患有代偿性肝硬化。五分之一的人患有糖尿病，14.3% 的人肥胖，41.8% 的人患有动脉高血压，35.2% 的人是吸烟者。基线时，平均 IMT 为 0.94 ± 0.29 mm，42.8% 的 IMT ≥1 mm，42.8% 有颈动脉斑块。结果 所有患者均获得了 12 周的持续病毒学应答。从基线到随访，IMT 显着降低（0.94 ± 0.29 mm 与 0.81 ± 0.27，p <0.001）。一致地，观察到颈动脉增厚患者从基线到随访显着降低（42.8% 对 17%，p <0.001），而颈动脉斑块没有变化（42.8% 对 47.8%， p = 0.34）。这些结果在按心血管危险因素和肝病严重程度分层的患者亚组中得到证实。结论 DAA 根除 HCV 可改善严重纤维化患者的颈动脉粥样硬化，伴或不伴其他代谢危险因素。从长远来看，这种改善动脉粥样硬化负担在减少主要心血管结局方面的影响值得研究。概述 通过直接作用抗病毒药物根除丙型肝炎病毒可改善晚期纤维化/代偿性肝硬化患者的颈动脉粥样硬化。在对肝脏疾病的严重程度和心血管危险因素进行分层后，证实了内膜中层厚度和颈动脉增厚的改善。