Clinical impact of direct-acting antiviral treatment on patients with hepatitis C virus–related oral lichen planus

Objectives Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease. It has been related to hepatitis C virus (HCV) infection as one of the extrahepatic pathologic manifestations. The current treatment for HCV infection with direct-acting antivirals (DAAs) is highly effective and safe. This study aimed to evaluate the impact of HCV eradication on OLP clinical manifestations. Methods Patients with a histologic diagnosis of OLP and HCV chronic infection were recruited from the oral medicine and internal medicine units of the University of Campania “Luigi Vanvitelli.” All patients received DAA treatment and were monitored at baseline and during and after treatment for liver function and antiviral response. Patients underwent an oral clinical examination before receiving DAAs (T0) and 8 weeks after the end of treatment (T1), and they were observed periodically in follow-up (FU). Statistical analysis was performed using Mann-Whitney and Wilcoxon tests, chi-square tests, and Fisher exact tests. Results Eighteen patients (13 females and 5 males; median age, 75 years) with chronic HCV infection of different genotypes were enrolled. All patients cleared HCV RNA with a sustained virologic response at FU. No adverse events were reported. The median FU was 92 weeks at T2. At T0, 5 patients presented with reticular and bilateral white lesions; 7 patients presented with erosive OLP; and 6 patients presented with a mixed form. The mean percentages of oral sites involved were 30% (±13.9) at T0, 20.8% (±12.9) at T1, and 16.2% (±15.2) at T2, showing improvement from T0 to T1 (P = .007) and T2 (P = .005). One patient developed oral cancer during the treatment and was excluded. Oral lesions have improved in 9 cases (52.9%) at T1 and in 10 cases (55.6%) at FU (T2); among these, 6 (60%) showed complete remission. However, statistical analysis did not reveal a significant correlation between oral improvement and HCV genotype (P = .64), viral load (P = .27), liver status (P = .60), isolated HBcAb positivity (P = .633), and type of DAA received (P = .103). Conclusions DAA treatment leading to HCV eradication can improve OLP symptoms. However, a causative relationship between HCV infection and OLP pathogenesis is difficult to establish. Further studies are necessary.