Clinics (Sao Paulo, Brazil) · 2026
Cardiac safety of sofosbuvir-based direct-acting antivirals in hepatitis C patients with pre-existing heart disease.
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Hanafy Amr Shaaban, Mohamed Mohamed Sorour, Attia Osama, Mohammed Ayman Fathy Elsayed, Hassaneen Ahmad M, Naguib Rania, Fahmy Eslam Kamal, Elkattawy Hany A
Аннотация
BACKGROUND: Direct-Acting Antivirals (DAAs) are effective in 95% of patients, but concerns about potential cardiotoxicity and decreased Warfarin Sensitivity (WS) need further investigation. The study aimed to evaluate the safety and effectiveness of sofosbuvir-based therapy in patients with significant heart diseases, considering potential drug interactions and their impact on cardiac function.
METHODS: The study involved 100 patients with HCV genotype 4, including 40 with ischemic heart disease, 20 with prosthetic valve replacement, 20 with NYHA class I‒II heart failure, and 20 with systemic hypertension. All received sofosbuvir-based antiviral therapy and underwent routine laboratory tests, N-Terminal B-type Natriuretic Peptide (NT-Pro BNP), abdominal ultrasound, and echocardiography at baseline and three months post-treatment.
RESULTS: Ninety-six patients achieved SVR, resulting in improved cardiac ejection fraction (EF) from 53.2 ± 8.8% to 56.2 ± 6.9% (p = 0.000) and reduced left atrial volume (LAV) from 43.2 ± 4.2 to 41.7 ± 3.9 mm (p = 0.008). Liver stiffness also improved (p = 0.013), and no disabling symptoms were reported. MAPSE increased from 8.4 ± 2.4 mm to 9.5 ± 2.5 mm, and interventricular septum thickness (IVT) decreased from 12.5 ± 1.8 mm to 10.9 ± 1.3 mm (p = 0.001 and P = 0.000, respectively). The warfarin dose needed to be increased to optimize INR after SVR, but this adjustment did not affect WS (p = 0.16).
CONCLUSION: Sofosbuvir-based antiviral therapy was well tolerated and demonstrated a reassuring cardiac safety profile in HCV patients with pre-existing heart disease, with no major arrhythmias or adverse cardiac events observed during or after therapy.
METHODS: The study involved 100 patients with HCV genotype 4, including 40 with ischemic heart disease, 20 with prosthetic valve replacement, 20 with NYHA class I‒II heart failure, and 20 with systemic hypertension. All received sofosbuvir-based antiviral therapy and underwent routine laboratory tests, N-Terminal B-type Natriuretic Peptide (NT-Pro BNP), abdominal ultrasound, and echocardiography at baseline and three months post-treatment.
RESULTS: Ninety-six patients achieved SVR, resulting in improved cardiac ejection fraction (EF) from 53.2 ± 8.8% to 56.2 ± 6.9% (p = 0.000) and reduced left atrial volume (LAV) from 43.2 ± 4.2 to 41.7 ± 3.9 mm (p = 0.008). Liver stiffness also improved (p = 0.013), and no disabling symptoms were reported. MAPSE increased from 8.4 ± 2.4 mm to 9.5 ± 2.5 mm, and interventricular septum thickness (IVT) decreased from 12.5 ± 1.8 mm to 10.9 ± 1.3 mm (p = 0.001 and P = 0.000, respectively). The warfarin dose needed to be increased to optimize INR after SVR, but this adjustment did not affect WS (p = 0.16).
CONCLUSION: Sofosbuvir-based antiviral therapy was well tolerated and demonstrated a reassuring cardiac safety profile in HCV patients with pre-existing heart disease, with no major arrhythmias or adverse cardiac events observed during or after therapy.