NEW HAVEN, CT—A year ago the VA announced it had eliminated chronic infections with hepatitis C virus in all veterans willing and able to be treated. More than 100,000 veterans achieved sustained virological response or a cure with the help of direct-acting antivirals between 2014 and 2019, an astonishing success without parallel in the private sector. Curing HCV dramatically reduced the risk advanced liver disease, cutting mortality rates by up to 50%.

Now that effective treatment for HCV is available an a large number of veterans with the infection cured, investigators are looking at post-cure management of patients. And, there, one troubling trend has captured significant attention.

New research indicates that some of the significant health gains associated with curing HCV could be lost as veterans who achieved SVR pack on the pounds.

“There are myriad complications associated with excess weight and obesity,” said Albert Do, MD, MPH, assistant professor of medicine at the Yale University School of Medicine and clinical director of the Yale Fatty Liver Disease Program in New Haven, CT. “At least 200 known complications have been reported, which span all organ systems and are interrelated, such as metabolic fatty liver disease, dyslipidemia, diabetes, and cardiovascular disease.”

As the VA provides the largest population of patients cured of HCV in the United States, Do and his colleagues at Yale and the VA Connecticut Healthcare System analyzed data from the VA Birth Cohort to determine whether veterans who achieved SVR with direct-acting antivirals (DAAs) gained weight and, if so, how much.

Of the 11,469 veterans in their study, 78% started HCV treatment at a body mass index (BMI) that indicated they were overweight or obese. Nearly all patients (97%) achieved SVR.

In the two years following treatment, just more than half the patients had gained weight. Of those, nearly 20% gained excess weight, which the researchers defined as in increase of 10 pounds or more during the period.

“The natural history of weight gain in the general population is an increase of a few points (one to three pounds) per year and so the reason we defined excess weight gain as such in our study is that it is clearly outside of this expected range in the general population,” Do told U.S. Medicine.

As the study did not include a comparator group, it remained unclear whether a similar proportion of veterans with HCV who were not treated or did not achieve SVR or veterans who had never been infected with HCV would also have gained excess weight.

In addition, the study looked only at veterans treated with DAAs. The interferon therapies used before the adoption of DAAs were widely associated with weight loss, at least initially. It is unknown whether patients gained weight after the much longer course of treatment ended, but Do suggested it was likely.

Still, Do urged veterans cured of HCV to closely monitor their weight.

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