丙型肝炎病毒 (HCV) 感染影响着全球 5000 万人，每年约有 242,000 人死亡，主要是由于肝硬化和肝细胞癌 (HCC) 等并发症。肝硬化引起的门脉高压（PH）会导致严重的后果，包括食管静脉曲张（EV）。本研究旨在评估直接作用抗病毒 (DAA) 治疗对患有和不患有 EV 的患者的有效性和安全性。这项回顾性分析涉及 2015 年 7 月 1 日至 12 月在 22 个波兰肝病中心连续接受 DAA 治疗的 HCV 感染成人。 2022 年 3 月 31 日。根据胃镜检查诊断出的 EV 的存在，对肝硬化患者进行分类。治疗效果通过持续病毒学应答 (SVR) 来衡量，并在治疗后监测 12 周的安全性结果。 3393 名 HCV 感染的肝硬化患者被分为有组 (A, n = 976) 和无组 (B, n = 2417) EV。 A 组的合并症和伴随药物的患病率显着较高。基因型 (GT)1b 感染在两组中均占主导地位，GT3 型感染在 EV 组中更为常见。 A 组表现出更严重的肝脏疾病，以及更高的失代偿率、HCC 和 HBV 合并感染率。 B 组的 SVR 显着较高（91.5% vs. 96.3%，p<<0.0001）。男性、GT3、EV 存在和 Child-Pugh B 级被确定为独立的阴性 SVR 预测因子。 A 组的安全性较差，不良事件发生率和死亡率明显较高。DAA 疗法对肝硬化患者非常有效且耐受性良好，但 EV 的存在预示病毒学反应较差。© 2024。作者。

Hepatitis C virus (HCV) infection affects 50 million people worldwide with around 242,000 deaths annually, mainly due to complications such as cirrhosis and hepatocellular carcinoma (HCC). Portal hypertension (PH) caused by cirrhosis leads to severe consequences, including esophageal varices (EV). This study aimed to evaluate the effectiveness and safety of direct-acting antiviral (DAA) treatment in patients with and without EV.This retrospective analysis involved consecutive HCV-infected adults undergoing DAA therapy at 22 Polish hepatology centers from July 1, 2015, to December 31, 2022. Patients with cirrhosis were categorized based on the presence of EV diagnosed by gastroscopy. Treatment effectiveness was measured by sustained virologic response (SVR), with safety outcomes monitored for 12 weeks post-treatment.A population of 3393 HCV-infected patients with cirrhosis was divided into groups with (A, n = 976) and without (B, n = 2417) EV. Group A showed a significantly higher prevalence of comorbidities and concomitant medications. Genotype (GT)1b infections predominated in both groups, and GT3 infections were more common in the EV group. Group A exhibited more severe liver disease, and higher rates of decompensation, HCC, and HBV co-infection. SVR was significantly higher in group B (91.5% vs. 96.3%, p < 0.0001). Male gender, GT3, EV presence, and Child-Pugh grade B were identified as independent negative SVR predictors. Group A had a worse safety profile, with notably higher adverse event incidence and mortality.DAA therapies are highly effective and well tolerated in patients with cirrhosis, but EV presence predicts poorer virologic responses.© 2024. The Author(s).