Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response

Abstract

BackgroundChronic hepatitis C (CHC) causes liver cirrhosis in 5%–20% of patients, leading to increased morbidity and mortality. This study aimed to estimate liver-related morbidity and mortality among patients with CHC and cirrhosis in Denmark with and without antiviral treatment and sustained virologic response (SVR). Furthermore we aimed to estimate the rate of hepatocellular carcinoma (HCC) and decompensation associated with certain prognostic factors.Materials and methodsPatients with CHC and cirrhosis registered in the Danish Database for Hepatitis B and C were eligible. Cirrhosis was based on liver biopsy, transient elastography, and clinical cirrhosis. Data were extracted from nationwide registries. The study period was from 2002 until 2013.ResultsOf 1,038 patients included, 716 (69%) were male and the median age was 52 years. Median follow-up was 3.8 years, 360 patients died, and 233 of 519 treated patients achieved SVR. Alcohol overuse and hepatitis C virus genotype 3 were associated with an increased incidence rate (IR) of HCC, whereas diabetes and alcohol overuse were associated with increased IRs of decompensation. Achieving SVR reduced all-cause mortality (adjusted mortality rate ratio 0.68 [95% CI 0.43–1.09]) and liver-related mortality (mortality rate ratio 0.6 [95% CI 0.36–1]), as well as liver-related morbidity with adjusted IR ratios of 0.37 (95% CI 0.22–0.62) for HCC and 0.31 (95% CI 0.17–0.57) for decompensation. The IRs of HCC and decompensation remained elevated in patients with alcohol overuse after SVR.ConclusionAlcohol overuse, hepatitis C genotype 3, and diabetes were associated with liver-related morbidity in patients with CHC and cirrhosis. SVR markedly reduced liver-related morbidity and mortality; however, special attention to patients with alcohol overuse should continue after SVR.

Modelling the potential prevention benefits of a treat‐all hepatitis C treatment strategy at global, regional and country levels: A modelling study

“…Globally, over 70 million people are infected with HCV . An estimated 400 000 people die annually due to HCV‐related disease …”

Hepatitis C virus elimination in Indonesia: Epidemiological, cost and cost‐effectiveness modelling to advance advocacy and strategic planning

“…These included assuming: (a) 50% of infected individuals are treated annually when the numbers of infected individuals is lower than the number of annual treatments available; (b) a stable general population HCV prevalence (rather than decreasing); (c) a lower general population anti‐HCV prevalence (0.8%); (d) a lower PWID anti‐HCV prevalence (50%); (e) a lower proportion of adults that are PWID (0.02%); (f) a higher viraemic HCV proportion (0.76), and (g) a lower (−50%) and higher (+50%) rate of progression from chronic infection to cirrhosis. We investigated selecting PWID for the first 32 000 treatments (total treatments over 2018‐2021), for whom infection rates tend to be high, selecting people with compensated cirrhosis for the first 32 000 treatments, and selecting those with decompensated cirrhosis for the first 32 000 treatments (patients with compensated and decompensated cirrhosis have higher mortality). Additionally, given the lack of Indonesia‐specific data on screening program yield to date, we examined a range of expected yields from general population screening (+50%, −50%).…”

Prevalence and Determinants of Kidney Markers among Subjects with Hepatitis C Virus Infection

“…Chronic viral hepatitis C (CVHC) predisposes to liver fibrosis and is a major cause of liver-related mortality and morbidity [1] [2]. With a global prevalence of 3% (71 million persons infected), CVHC infection is a major public health problem worldwide [1] [3].…”