Does rheumatoid arthritis affect the course of chronic hepatitis C and outcomes of antiviral treatment?

INTRODUCTION: Chronic hepatitis C virus (HCV) infection is a systemic disease frequently associated with extrahepatic autoimmune conditions, including rheumatoid arthritis (RA). Immune dysregulation and immunomodulatory therapy may raise concerns about the effectiveness and safety of direct-acting antivirals (DAAs), while real-world data in RA patients remain limited. OBJECTIVES: To assess whether the presence of RA influences the severity of liver disease and the outcomes of direct-acting antiviral (DAA) therapy in HCV-infected patients. PATIENTS AND METHODS: This retrospective multicenter study included adult HCV-infected patients treated with DAAs between 2015 and 2024 in Polish centers. We compared patients with RA with those without autoimmune disease (non-AID). RESULTS: Of 20 645 patients included in the analysis, 206 (1.0%) had RA. They were older, predominantly female, had lower BMI, and less advanced liver fibrosis as compared to the non-AID group. The SVR rates were high and comparable between RA and non-AID populations (98.4% vs 97.7%). RA was not associated with treatment failure. Independent predictors of virologic failure included male sex, genotype 3 infection, prior treatment, advanced liver disease, and Child-Pugh class B/C. Mild adverse events were more frequent in RA patients, while serious adverse events, deaths, and treatment discontinuation rates were comparable. CONCLUSIONS: RA does not contribute to increased severity or progression of HCV-related liver disease and does not negatively affect the effectiveness or safety of DAA therapy. Liver disease stage and hepatic dysfunction, rather than the presence of RA, are the key determinants of treatment outcomes in patients with chronic HCV infection.