HCV-Infected Individuals have Higher Prevalence of Comorbidity and Multimorbidity: A retrospective cohort study

Abstract

Background Almost 1% of Canadians are hepatitis C (HCV)-infected. The liver-specific complications of HCV are established but the extra-hepatic comorbidity, multimorbidity, and its relationship with HCV treatment, is less well known. We describe the morbidity burden for people with HCV and the relationship between multimorbidity and HCV treatment in the pre- and post-direct acting antiviral (DAA) era. Methods We linked adults with HCV at The Ottawa Hospital Viral Hepatitis Program as of April 1, 2017 to provincial health administrative data and matched on age and sex to 5 Ottawa-area residents for comparison. We used validated algorithms to identify the prevalence of mental and physical health comorbidities, as well as multimorbidity (2+ comorbidities). We calculated direct age- and sex-standardized rates of comorbidity and comparisons were made by interferon-based and DAA HCV treatments. Results The mean age of the study population was 54.5 years (SD 11.4), 65% were male. Among those with HCV, 4% were HIV co-infected, 26% had liver cirrhosis, 47% received DAA treatment, and 57% were cured of HCV. After accounting for age and sex differences, the HCV group had greater multimorbidity (prevalence ratio (PR) 1.38, 95% confidence interval (CI) 1.20 to 1.58) and physical-mental health multimorbidity (PR 2.71, 95% CI 2.29 – 3.20) compared to the general population. Specifically, prevalence ratios for people with HCV were significantly higher for diabetes, renal failure, cancer, asthma, chronic obstructive pulmonary disease, substance use disorder, mood and anxiety disorders and liver failure. HCV treatment and cure were not associated with multimorbidity, but treatment prevalence was significantly lower among middle-aged individuals with substance use disorders despite no differences in prevalence of cure among those treated. Conclusion People with HCV have a higher prevalence of comorbidity and multimorbidity compared to the general population. While HCV treatment was not associated with multimorbidity, people with substance use disorder were less likely to be treated. Our results point to the need for integrated, comprehensive models of care delivery for people with HCV.

Real-World Outcomes in Historically Underserved Patients with Chronic Hepatitis C Infection Treated with Glecaprevir/Pibrentasvir

“…PWUD bear a high burden of chronic HCV infection, with injection drug use accounting for 70% of all new infections which may be attributed to the opioid epidemic [5,8]. In comparison to the general public, patients with HCV have a higher burden of comorbidities and multimorbidity, including a much higher burden of mental health and substance and/or alcohol abuse disorders [22]. Modeling studies have shown that treatment and successful cure of persons who inject drugs, a population at high risk for transmission of HCV, may decrease prevalence and incidence rates of HCV infections [9,41,42].…”

“…In clinical practice, patient populations may be more diverse and potentially less adherent to treatment versus those in clinical trials [21], which could impact the safety and effectiveness of DAAs in these settings. Compared with the general population, people with HCV have a higher prevalence of comorbidity and multimorbidity [22], and patients with dual disorders, such as substance and/or alcohol abuse combined with psychiatric disorders, were historically excluded from registrational trials. It is therefore crucial to assess the effectiveness and safety of pangenotypic DAAs in real-world populations, particularly among PWUD and patients with other single or dual disorders.…”

Liver disease symptoms are associated with higher risk of adverse clinical outcomes: A longitudinal study of North American adults with chronic Hepatitis B

“…These patients tended to be non‐Asian, born in the United States/Canada, had more advanced liver disease and a higher number of medical comorbidities and medication use. These findings may help clinicians identify patients at risk for worse symptoms during the course of their CHB; it is also possible that patients' symptoms are aggravated by an interaction of multimorbidity and/or concomitant medications, not solely liver disease 19 . However, when we conducted a sensitivity analysis excluding patients with comorbidities from the prediction of worse symptoms, higher AST and lower platelet counts remained significantly associated with worse symptoms, thus providing evidence that CHB disease changes are partially responsible for worse symptoms.…”