Direct Acting Antivirals and the Risk of Arrhythmias and Conduction Disorders in Patients With Chronic Hepatitis C

This study quantifies the risk of arrhythmias and conduction disorders (ACD) in patients receiving direct-acting antiviral (DAA) therapy for hepatitis C. All individuals aged 18 to 85 treated with DAAs between 01/01/2014 and 12/31/2021 were selected from the French national healthcare database (SNDS). The primary outcome was the incidence of hospitalization or medical procedure for ACD. After analyzing 87 589 individuals from 01/01/2014 to 12/31/2021, 2131 hospitalizations or medical procedures for ACD were observed over 672 572 person-years (PY) of follow-up. The incidence of ACD was 245/100 000 PY (95% confidence interval (CI), 228 to 263/100 000 PY) before DAA and 375/100 000 PY (95% CI, 355 to 395/100 000 PY) after DAA exposure (rate ratio 1.53; 95% CI, 1.40 to 1.68; P < .001). The risk of ACD was increased after DAA exposure, compared to the pre-DAA period (adjusted hazard ratio,1.66; 95% CI, 1.43 to 1.93; P < .001). A significant increase in the risk of ACD was observed in the population-level cohort of individuals treated with DAAs, regardless of the regimen. Further research is needed to identify patients at risk of ACD, determine cardiac monitoring strategies, and evaluate the need for holter monitoring after DAA therapy.

Abstract