BACKGROUND The real-world, long-term benefits of sustained virologic response (SVR) on the risk of variceal bleeding remain unclear. AIM To assess the association between DAA-induced SVR and post-treatment variceal bleeding METHODS: We identified patients who initiated DAA-only anti-viral treatments in the United States Veterans Affairs healthcare system from 2013 to 2015. We followed patients until 1 January 2019 for the development of gastro-oesophageal variceal bleeding defined by diagnostic codes. We used multivariable Cox proportional hazards regression to assess the association between SVR and development of variceal bleeding, adjusting for potential confounders. RESULTS Among 33 582 DAA-treated patients, 549 (1.6%) developed variceal bleeding after treatment (mean follow-up 3.1 years). Compared to no SVR, SVR was associated with a significantly lower incidence of variceal bleeding among all patients (0.46 vs 1.26 per 100 patient-years, adjusted hazard ratio [AHR] 0.66, 95% CI 0.52-0.83), among patients with pre-treatment cirrhosis (1.55 vs 2.96 per 100 patient-years, AHR 0.73, 95% CI 0.57-0.93) and among patients without pre-treatment cirrhosis (0.07 vs 0.29 per 100 patient-years, AHR 0.33, 95% CI 0.17-0.65). The risk of variceal bleeding after treatment was lower in those who achieved SVR vs no SVR among patients who had non-bleeding varices (3.5 vs 4.9 per 100 patient-years) or bleeding varices (12.9 vs 16.4 per 100 patient-years) diagnosed before treatment, but these differences were not statistically significant in adjusted analyses. CONCLUSION DAA-induced SVR is independently associated with a lower risk of variceal bleeding during long-term follow-up in patients with and without pre-treatment cirrhosis. These findings demonstrate an important real-world benefit of DAA treatment.

中文翻译：

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用直接作用的抗病毒剂消灭丙型肝炎可降低静脉曲张破裂出血的风险。

背景技术持续的病毒学应答（SVR）对于静脉曲张破裂出血风险的现实，长期益处尚不清楚。目的评估DAA引起的SVR与治疗后静脉曲张破裂出血之间的关联方法：我们确定了2013年至2015年在美国退伍军人事务医疗系统中开始仅使用DAA的抗病毒治疗的患者。我们追踪患者直至2019年1月1日诊断代码所定义的胃食管静脉曲张破裂出血的发生。我们使用多变量Cox比例风险回归来评估SVR与静脉曲张破裂出血之间的关联，并针对潜在的混杂因素进行了调整。结果在33 582例接受DAA治疗的患者中，有549例（占1.6％）在治疗后发展为静脉曲张破裂出血（平均随访时间为3。1年）。与没有SVR相比，在治疗前肝硬化的患者中，SVR与曲张静脉出血的发生率显着降低（每100个患者年0.46比1.26，调整后的危险比[AHR] 0.66，95％CI 0.52-0.83）。每100病人年2.96，AHR 0.73，95％CI 0.57-0.93）和无治疗前肝硬化的患者（每100病人年0.07 vs 0.29，AHR 0.33，95％CI 0.17-0.65）。在没有出血前静脉曲张（每100例患者每年3.5 vs 4.9）或之前诊断为出血性静脉曲张（每100例患者每年12.9 vs 16.4）的患者中，获得SVR的患者治疗后静脉曲张出血的风险较低。治疗后，这些差异在调整后的分析中无统计学意义。结论DAA诱导的SVR与有或没有治疗前肝硬化的患者长期随访期间曲张静脉出血的风险较低独立相关。这些发现表明，DAA治疗具有重要的现实意义。