Original Article

Prevalence of HCV Infection in Adults with Congenital Heart Disease and Treatment with Direct Antiviral Agents

Authors: Ajay Reddy Gade MBBS, Manisha Patel MD, Donna R. West MSN, Gary A. Abrams MD


Objectives: Hepatitis C virus (HCV) infection affects >3% of the US population, which over time can lead to cirrhosis and hepatocellular carcinoma. The lack of a reliable screening method for HCV before 1992 resulted in a higher prevalence of the virus in adults with congenital heart disease who underwent corrective surgery that required blood transfusions. Direct-acting antiviral agents such as sofosbuvir/ledipasvir have significantly increased the efficacy of HCV therapy, although use of these medications in adults with congenital heart disease has not been described.

Methods: Ours was a retrospective study of 188 adults with congenital heart conditions who had cardiac surgery before 1992. These patients were screened for HCV using HCV antibody followed by HCV RNA if the screening test was positive.

Results: Of the 188 adults, 116 (43% male patients, 24–70 years) were screened for the HCV antibody, demonstrating that 104 individuals were negative and 12 subjects were positive for the virus. Subsequently, further testing for the presence of HCV demonstrated 11 of 12 were infected, with an overall prevalence of 9.5%. Five individuals chose to be treated with sofosbuvir/ledipasvir and 5 of 5 have successfully cleared the virus and are considered cured.

Conclusions: Adults with congenital heart disease who underwent cardiac surgery before 1992 warrant being screened for HCV, and, if testing positive, may be considered for therapy using direct-acting antiviral agents with close monitoring for cardiac complications.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Vogt M, Muhlbauer F, Braun SL, et al. Prevalence and risk factors of hepatitis C infection after cardiac surgery in childhood before and after blood donor screening. Infection 2004;32:134-137.
2. Wang A, Book WM, McConnell M, et al. Prevalence of hepatitis C infection in adult patients who underwent congenital heart surgery prior to screening in 1992. Am J Cardiol 2007;100:1307-1309.
3. Cox DA, Ginde S, Tweddell JS, et al. Outcomes of a hepatitis C screening protocol in at-risk adults with prior cardiac surgery. World J Pediatr Congenit Heart Surg 2014;5:503-506.
4. Kim WR. The burden of hepatitis C in the United States. Hepatology 2002;36(5 Suppl 1):S30-S34.
5. Alter MJ, Kruszon Moran D, Nainan OV, et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med 1999;341:556-562.
6. Centers for Disease Control and Prevention. Hepatitis C FAQs for health professionals. http://www.cdc.gov/hepatitis/hcv/hcvfaq.htm# section1. Updated January 27, 2017. Accessed December 27, 2017.
7. Simmonds P, Bukh J, Combet C, et al. Consensus proposals for a unified system of nomenclature of hepatitis C virus genotypes. Hepatology 2005;42:962-973.
8. Shiffman ML. Chronic Hepatitis C Virus: Advances in Treatment, Promise for the Future. New York: Springer-Verlag , 2011:103-104.
9. Afdhal N, Zeuzem S, Kwo P, et al. Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. N Engl J Med 2014;370:1889-1898.
10. National Viral Hepatitis Roundtable. Estimate of people with hepatitis C in South Carolina. http://nvhr.org/content/nvhr-hepatitis-c-state-specific-resources-pages. Published 2014. Accessed August 2, 2016.
11. Poordad F, Dieterich D. Treating hepatitis C: current standard of care and emerging direct-acting antiviral agents. J Viral Hepat 2012;19:449-464.
12. Zeuzem S, Ghalib R, Reddy KR, et al. Grazoprevir-elbasvir combination therapy for treatment-naive cirrhotic and noncirrhotic patients with chronic hepatitis C virus genotype 1, 4, or 6 infection: a randomized trial. Ann Intern Med 2015;163:1-13.
13. Chahine EB, Sucher AJ, Hemstreet BA. Sofosbuvir/velpatasvir: the first pangenotypic direct-acting antiviral combination for hepatitis C. Ann Pharmacother 2017;51:44-53.
14. Talavera Pons S, Boyer A, Lamblin G, et al. Managing drug-drug interactions with new direct-acting antiviral agents in chronic hepatitis C. Br J Clin Pharmacol 2017;83:269-293.
15. Renet S, Chaumais MC, Antonini T, et al. Extreme bradycardia after first doses of sofosbuvir and daclatasvir in patients receiving amiodarone: 2 cases including a rechallenge. Gastroenterology 2015;149:1378-1380. e1.
16. de Kanter CT, Drenth JP, Arends JE, et al. Viral hepatitis C therapy: pharmacokinetic and pharmacodynamic considerations. Clin Pharmacokinet 2014;53:409-427.
17. Back DJ, Burger DM. Interaction between amiodarone and sofosbuvir-based treatment for hepatitis C virus infection: potential mechanisms and lessons to be learned. Gastroenterology 2015;149:1315-1317.
18. Hill L. Hepatitis C virus direct-acting antiviral drug interactions and use in renal and hepatic impairment. Top Antivir Med 2015;23:92-96.
19. Asrani SK, Asrani NS, Freese DK, et al. Congenital heart disease and the liver. Hepatology 2012;56:1160-1169.
20. Ghaferi AA, Hutchins GM. Progression of liver pathology in patients undergoing the Fontan procedure: chronic passive congestion, cardiac cirrhosis, hepatic adenoma, and hepatocellular carcinoma. J Thorac Cardiovasc Surg 2005;129:1348-1352.
21. Wu F, Ukomadu C. When and how to test for liver disease in the Fontan population. http://www.acc.org/latest-in-cardiology/articles/2014/07/18/12/55/when-and-how-to-test-for-liver-disease-in-the-fontan-population. Published April 16, 2013. Accessed December 27, 2017.
22. Simonetto DA, Yang HY, Yin M, et al. Chronic passive venous congestion drives hepatic fibrogenesis via sinusoidal thrombosis and mechanical forces. Hepatology 2015;61:648-659.
23. AASLD/IDSA HCV Guidance Panel. Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology 2015;62:932-954.