All-Cause Mortality Is Higher With Chronic Hepatitis C

Megan Brooks

June 17, 2011

NEW YORK (Reuters Health) June 17, 2011 — Chronic hepatitis C doubles the normal risk of dying early from any cause, a new study shows.

That higher risk persists even after accounting for liver-related morbidity, and patients with chronic hepatitis C virus (HCV) infection should be closely monitored, the study team wrote in the June 10 online issue of Clinical Infectious Diseases.

Dr. Samer El-Kamary, who led the study, said he hopes these results "will encourage clinicians to test their patients for HCV whenever they suspect an infection, and not wait for clear signs of liver disease."

Also, he said in email to Reuters Health, "When HCV infection is diagnosed... consider earlier therapy even if there is no underlying liver disease."

Dr. El-Kamary, of the University of Maryland School of Medicine in Baltimore, and colleagues used the Third National Health and Nutrition Examination Survey (NHANES III) to analyze liver-related and non-liver-related mortality among 16,509 HCV-infected individuals, age 17 and older, in the general US population. HCV status was assessed from 1988 to 1994, with follow-up through 2006.

During a median of 14.3 years, 3,853 deaths occurred. Death rates were highest in those with chronic HCV infection and lowest in HCV-negative individuals.

For every 1000 person-years, there were 11.1 deaths in anti-HCV negative patients, compared with 14.8 and 16.5 deaths in the anti-HCV positive and chronic hepatitis C groups, respectively.

In a subset of 9,378 participants, after adjusting for all covariate risk factors, HCV-positive status was associated with a 2.11 higher all-cause mortality rate compared with HCV-negative status. Chronic HCV status was linked with a 2.37-fold higher all-cause mortality rate.

Anti-HCV positive individuals and chronically HCV-infected individuals also had a roughly 20-fold and 26-fold higher rate of liver-related mortality, respectively.

However, non–liver-related deaths were not significantly associated with HCV status, the authors found.

On the other hand, extrapolating their data to the population at large, they discovered that 57.8% of the estimated 31,163 deaths due to any cause that occur annually among the 2.46 million American adults with chronic hepatitis C are directly attributable to chronic HCV infection.

Similarly, they say 52.6% of the estimated 33,759 deaths that occur in the 3.2 million HCV-positive adults are attributable to the presence of anti-HCV.

Among the estimated 9,390 annual liver-related deaths among anti-HCV positive individuals and the 9,569 annual liver-related deaths among chronic HCV-infected individuals, 94.9% and 96.2% were attributable to HCV, respectively.

"This study suggests that mortality among HCV-infected individuals in the general US population is higher than previously described," the authors note.

"Given these findings, and the greater availability and affordability of various HCV testing methods, perhaps increased testing, earlier therapy, and closer monitoring of all HCV-positive individuals, particularly those with non-liver-related morbidities, should be considered by health care providers," they conclude.

The question is: Can anti-HCV therapy mitigate the lifespan hit imposed by HCV infection?

Dr. El-Kamary said: "We know that among those with liver disease, successful treatment definitely improves patients' survival. However, since HCV therapy is almost exclusively offered to those with liver disease, little is known about the impact on those without liver disease. We hope that this study will encourage others to evaluate the impact of treatment on HCV-infected patients without liver disease."

In May 2011, the US Food and Drug Administration approved 2 new drugs for HCV: telaprevir (Incivek, Vertex Pharmaceuticals) and boceprevir (Victrelis, Merck & Co).

At the time, Edward Cox, director of the FDA drug center's office of antimicrobial products said these two drugs present "important new treatment options for hepatitis C that offer a greater chance at a cure for some patients with this serious condition."

Clin Infect Dis. Published online June 10, 2011. Abstract

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