Risk factors for virological relapse and long-term efficacy of direct-acting antiviral agents in chronic hepatitis C infection: Impact of HIV coinfection and renal function changes

Although direct-acting antiviral agents (DAAs) have significantly increased the cure rate of hepatitis C, the risk factors for virological recurrence and dynamic changes in liver and kidney functions after treatment in the real world still need to be further clarified. A total of 196 patients with hepatitis C virus (HCV) infection admitted to Henan Infectious Disease Hospital from January 2022 to July 2025 were retrospectively included. Baseline data and laboratory indicators at 12 weeks after the end of DAA treatment, sustained virological response (SVR) rate at 12 and 24 weeks after the end of treatment were collected. Changes in liver function, noninvasive liver fibrosis score and safety indicators before and after treatment were compared. The binary logistic regression model was used to analyze the influencing factors of recurrence in patients with HCV. The virological recurrence rate after DAA treatment was 5.10% (10/196), and platelet count, albumin, total bilirubin, alanine aminotransferase, aspartate aminotransferase, α-fetoprotein, and aminotransferase to platelet ratio index decreased significantly after treatment (all P < .05). All 10 relapsed patients achieved SVR12, while 4 did not reach SVR24. The time interval from achieving SVR12 to relapse ranged from 5 to 63 weeks. The results of logistic multivariate analysis showed that a previous history of hepatitis C treatment and concurrent HIV infection were risk factors for hepatitis C recurrence in patients. In this real-world cohort, DAA therapy achieved high 12-week efficacy (SVR12 100%), but 5.10% of patients experienced virological relapse within 63 weeks. Achievement of SVR12 was accompanied by significant improvements in liver function and noninvasive fibrosis scores. Prior HCV treatment experience and HIV coinfection were independent predictors of relapse, underscoring the need for prolonged RNA monitoring in these subgroups.