HCV RNA Predicts Death from End Stage Liver Disease  

In a surprising finding that contradicts the results of several prior studies, Michie Hisada, MD, and colleagues at the National Institutes of Health conclude that based on results of their NIH study in injection drug users, “HCV RNA level is a predictor of end stage liver disease (ESLD).”

The NIH study results appear in the most recent issue of Hepatology (December 2005), and are summarized here.

Individuals with chronic hepatitis C virus (HCV) who are coinfected with HIV and human T-lymphotropic virus type II (HTML-II) are at high risk for end-stage liver disease (ESLD). In the current study, conducted in a cohort of 6,570 injection drug users who enrolled in 9 US cities between 1987 and 1991, researchers evaluated whether ESLD death was associated with HCV RNA level or specific HCV protein antibodies among persons with or without HIV/HTLV-II coinfection.

The investigators compared 84 ESLD descendents and 305 randomly selected cohort participants with detectable HCV RNA, stratified by sex, race, HIV, and HTLV-II strata. Relative hazard (RH) of ESLD death was derived from the proportional hazard model.

Risk of ESLD death was unrelated to the intensity of antibodies against the HCV c-22(p), c-33(p), c-100(p), and NS5 proteins, individually or combined, but it increased with HCV RNA level, say the researchers. The association between HCV RNA level and ESLD death remained significant after adjustment for alcohol consumption.

Deaths from AIDS (n = 45) and other causes (n = 43) were unrelated to HCV RNA. HIV infection was not associated with ESLD risk in multivariate analyses adjusted for HCV RNA.

Men had an increased risk of ESLD death in unadjusted analyses but not in multivariate analysis. Non-black patients were at increased risk for ESLD death.

Based on these results, the NIH researchers conclude, “HCV RNA level is a predictor of ESLD death among persons with chronic HCV infection.” (Link to an  also editorial on this unexpected finding).

12/13/05

Reference
ichie Hisada and others. Hepatitis C virus load and survival among injection drug users in the United States. Hepatology 42(6): 1446 – 1452. December 2005.