Impact of direct-acting antiviral (DAA) treatment for hepatitis C on pulmonary hemodynamics

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Cases of portopulmonary hypertension (PoPH) developing after DAA therapy for hepatitis C virus (HCV) infection have been reported. The purpose of the study was to assess the effects of DAA treatment for HCV infection on pulmonary hemodynamics. 91 patients with liver cirrhosis and clinically significant portal hypertension (hepatic venous pressure gradient, HVPG≥10 mmHg) were evaluated. Right heart catheterization and HVPG measurement were performed at baseline (BL), 6 months (6m) and 2 years (2y) after finishing DAA treatment. Results: All patients achieved sustained viral response. Results on pulmonary hemodynamics and HVPG are shown in Table 1. Mean Pulmonary artery pressure (PAP) increase by 2 mmHg at 6m and remained stable at 2y assessment. One patient (1.1%) had PoPH (PAP>20mmHg, PVR >3UWood) at BL, 2 (2.1%) at 6m, and 4(4.4%) at 2y after finishing DAA therapy. The HVPG decreased significantly after 6m and decreased further after 2y. At 2y 20(22%) patients had HVPG <10mmHg. There was inverse correlation between the decrease in HVPG and the increase in PVR (r=0.20, p=0.03). Conclusions: DAA treatment for HCV infection produces an increase in PAP that in a reduce proportion of patients leads to the development of pulmonary hypertension. Evaluation with echocardiography before starting DAA therapy and up to 2 years after finishing it is recomended.

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