Some recent studies have found an association between hepatitis C virus (HCV) infection and cardiovascular disease, including carotid atherosclerosis. The authors were interested in whether HCV eradication using direct-acting antivirals (DAA) improves carotid atherosclerosis in HCV-infected patients with advanced fibrosis/compensated cirrhosis. They enrolled 182 consecutive patients with HCV and advanced fibrosis or compensated cirrhosis. All patients were treated with DAAs according to AISF/EASL guidelines. Intima-media thickness (IMT), carotid thickening (IMT ≥1 mm) and carotid plaques (focal thickening of ≥1.5 mm at the level of the common carotid), were assessed using ultrasonography (US) at baseline and 9-12 months following the end of therapy. 56% of patients were male, their mean age was 63.1 years and 65.9% had compensated cirrhosis. 20% had diabetes, 14.3% were obese, 41.8% had arterial hypertension and 35.2% were smokers. At baseline, the mean IMT was 0.94 mm, 42.8% had IMT ≥1 mm and 42.8% had carotid plaques. All of the patients achieved a sustained virologic response 12 weeks following end of therapy. IMT significantly decreased from baseline to follow-up (0.94 mm vs. 0.81 mm). There was also a significant reduction in the prevalence of patients with carotid thickening from baseline to follow-up (42.8% vs. 17%), while no changes were seen for carotid plaques. Therefore HCV eradication using DAAs improves carotid atherosclerosis in patients with severe fibrosis with or without additional metabolic risk factors.
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