How Does Hepatitis C Cure Affect the Long-Term Risk of Death?
Among hepatitis C infection patients even after complete cure they still face a significantly elevated risk of death when compared to the general population ().
The study, published by The BMJ, is based on data from more than 20,000 patients with a hepatitis C cure. Hepatitis C is a virus that can infect the liver which, if left untreated, can cause serious and potentially life-threatening liver damage over many years.
Assessing Mortality Rates in Hepatitis C Cured Patients
Historically, hepatitis C was treated with interferon-based therapy, which was often ineffective.But in 2011, new medications called direct acting antivirals (DAA) were developed.Now more than 95 percent of patients treated with DAAs achieve a "virological cure" and have a significantly lower risk of death than untreated patients.Yet the question of what prognosis cured patients can expect compared with the general population remains the subject of debate.To explore this further, a team of the UK and Canadian researchers set out to measure mortality rates in individuals with a hepatitis C cure and assess how these rates compare with the general population.‘Among hepatitis C infection patients, increased mortality risk ranges from three to 14 times higher, depending on the stage of liver disease. #hepatitis #hepatitistypes #liverdisease’
They analysed data from three population studies carried out in British Columbia (Canada), Scotland and England involving 21,790 individuals who achieved a hepatitis C cure between 2014 and 2019.Most participants did not have cirrhosis at cure. The average age of pre-cirrhosis patients in Scotland was 44 years and 56 years in British Columbia.A total of 1,572 (7 percent) of participants died during follow-up. The leading causes of death were drug related (24 percent), liver failure (18 percent) and liver cancer (16 percent).After taking account of age, death rates were considerably higher than the general population across all disease severity groups and settings.
Impact of Disease Severity on Mortality Rates in Hepatitis C Patients
Rates also increased appreciably with liver disease severity. For patients without cirrhosis, the leading cause of excess death was drug related, whereas in patients with cirrhosis, the two leading drivers were liver cancer and liver failure.Across all disease stages and settings, older age, recent substance use, alcohol use and pre-existing conditions (co-morbidities) were associated with higher death rates.These are observational findings and the researchers acknowledge that they may not apply to all settings, particularly where injecting drug use is not the dominant mode of hepatitis C transmission.However, this is the largest and most representative study performed to date and the researchers say their results "show unequivocally that cured patients continue to face substantial mortality rates, driven by liver and drug-related causes. As such, they highlight the importance of establishing robust post-cure follow-up pathways, as well as services and interventions to prevent drug and alcohol-related harms, to fully realize the benefits of a hepatitis C cure."
Reference:
- People with a hepatitis C cure still face substantial risk of death - (https:www.bmj.com/company/newsroom/people-with-a-hepatitis-c-cure-still-face-substantial-risk-of-death/)