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 uptake and cure 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 interferon-free, 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.

Subclinical Hepatitis C Virus Infection in Patients with Chronic Obstructive Pulmonary Disease: Evidence from a Cross-Sectional Multicenter Observation Study

“…Therefore, there is a need for clinical trials to evaluate the efficacy and tolerance of the direct-acting antiviral agents for the treatment of HCV-associated renal diseases. In the present study, we found a comparatively low prevalence of HCV in COPD patients compared to previous studies worldwide (25,26). The reports on the association between HCV infection and COPD are exiguous.…”

Сlinical and immunological status of patients with chronic hepatitis С on the background of comorbidity

“…Распространенность коморбидной патологии в нашем исследовании выявлена у 63% пациентов с ХГС, также в 1/2 случаев имела место мультиморбидность. В ряде научных наблюдений отмечается более высокая распространенность как коморбидности, так и мультиморбидности у пациентов с ХГС в сравнении с общей популяцией [7,8]. Существует много сообщений о более высокой летальности у пациентов с ХГС при наличии различной сопутствующей патологии [9,10].…”

The burden of serious non-AIDS-defining events among admitted cART-naive AIDS patients in China: An observational cohort study

“…It was reported that, besides liver fibrosis and cirrhosis, extra-hepatic comorbidities including malignancies, cardiovascular diseases, CKD, and neurological diseases were well established in HCV-infected population [ 32 ]. Chronic viral infection, including HIV and HCV, induced to generate systemic chronic inflammation, which was more prone to cause serious noncirrhotic liver diseases (NCDs) via some mechanisms including oxidative stress and mitochondrial dysfunction [ 33 ].…”