VA Pittsburgh Healthcare System, Pittsburgh, PA.
University of Pittsburgh School of Medicine, Pittsburgh, PA.
Hepatology. 2015 Aug;62(2):365-74. doi: 10.1002/hep.27835. Epub 2015 May 23.
3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have been variably noted to affect hepatitis C virus (HCV) treatment response, fibrosis progression, and hepatocellular carcinoma (HCC) incidence, with some having a more potent effect than others. We sought to determine the impact of adding statins to antiviral therapy upon sustained virological response (SVR) rates, fibrosis progression, and HCC development among HCV-infected persons using the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), an established, longitudinal, national cohort of HCV-infected veterans. Within ERCHIVES, we identified those who received HCV treatment and a follow-up of >24 months after treatment completion. We excluded those with human immunodeficiency virus coinfection, hepatitis B surface antigen positivity, cirrhosis, and HCC at baseline. Our main outcomes were liver fibrosis progression measured by FIB-4 scores, SVR rates, and incident HCC (iHCC). Among 7,248 eligible subjects, 46% received statin therapy. Statin use was significantly associated with attaining SVR (39.2% vs. 33.3%; P < 0.01), decreased cirrhosis development (17.3% vs. 25.2%; P < 0.001), and decreased iHCC (1.2% vs. 2.6%; P < 0.01). Statins remained significantly associated with increased odds of SVR (odds ratio = 1.44; 95% confidence interval [CI] = 1.29, 1.61), but lower fibrosis progression rate, lower risk of progression to cirrhosis (hazard ratio [HR] = 0.56; 95% CI = -0.50, 0.63), and of incident HCC (HR = 0.51; 95% CI = 0.34, 0.76) after adjusting for other relevant clinical factors.
Statin use was associated with improved virological response (VR) rates to antiviral therapy and decreased progression of liver fibrosis and incidence of HCC among a large cohort of HCV-positive Veterans. These data support the use of statins in patients with HCV.
3-羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）对丙型肝炎病毒（HCV）治疗反应、纤维化进展和肝细胞癌（HCC）的发生有不同程度的影响，其中一些药物的影响比其他药物更显著。我们试图通过电子检索的 HCV 感染退伍军人队列（ERCHIVES）来确定在 HCV 感染人群中添加他汀类药物对抗病毒治疗后的持续病毒学应答（SVR）率、纤维化进展和 HCC 发展的影响，这是一个已建立的、纵向的、全国性的 HCV 感染退伍军人队列。在 ERCHIVES 中，我们确定了那些接受 HCV 治疗且在治疗完成后随访时间超过 24 个月的患者。我们排除了那些同时感染人类免疫缺陷病毒、乙型肝炎表面抗原阳性、肝硬化和 HCC 的患者。我们的主要结局是通过 FIB-4 评分测量的肝纤维化进展、SVR 率和 HCC 发生率（iHCC）。在 7248 名合格患者中，46%接受了他汀类药物治疗。他汀类药物的使用与 SVR 率的提高显著相关（39.2%比 33.3%；P<0.01），肝硬化的发展减少（17.3%比 25.2%；P<0.001），iHCC 减少（1.2%比 2.6%；P<0.01）。他汀类药物仍与 SVR 发生率的增加显著相关（比值比=1.44；95%置信区间[CI]：1.29，1.61），但纤维化进展率较低，进展为肝硬化的风险较低（风险比[HR]：0.56；95%CI：0.50，0.63），以及 HCC 发生率较低（HR：0.51；95%CI：0.34，0.76），这在调整了其他相关临床因素后仍然存在。
在一个大型 HCV 阳性退伍军人队列中，他汀类药物的使用与抗病毒治疗后的病毒学反应（VR）率提高以及肝纤维化进展和 HCC 发生率降低相关。这些数据支持在 HCV 患者中使用他汀类药物。
