By Liz Highleyman

Over years or decades, a proportion of people with chronic hepatitis C virus (HCV) infection will develop advanced liver disease, including cirrhosis, hepatocellular carcinoma (liver cancer), and end-stage liver failure. Studies have shown, however, that among individuals who achieve sustained virological response to interferon-based therapy, fibrosis progression may be slowed, halted, and possibly even reversed.

As reported in the August 2008 Journal of Hepatology, French researchers used mathematical modeling to analyze the impact of antiviral therapy on the rate of mortality due to HCV.

The investigators used data from 2 recent treatment studies. The population of French people with HCV was simulated from infection to death using a computer-based model. The researchers took into account the impact of alcohol consumption, HCV screening, and antiviral therapy to predict HCV mortality during the 2006-2025 period, and to assess the impact of viral eradication.

Results

• In 2006, the model estimated that among HCV RNA positive individuals:

• 55% had absent or mild liver fibrosis (F0-F1);
• 18% had moderate fibrosis (F2);
• 22% had severe fibrosis or cirrhosis (F3-F4);
• 6% had liver complications.

• The mortality ratio was 11-fold higher among alcoholic patients 40-65 years old compared with younger non-alcoholic individuals.

• The model predicted that current therapy will save 14,400 lives (95% CI 13,900-15,000) compared with absence of therapy.

• If patients with fibrosis stages < F2 were to be treated in the same proportions as those with F2 -- contrary to current guidelines -- an additional 700 lives would be saved.

• If HCV screening were to reach 75% of the population by 2010 -- 4 years earlier than model expectations -- 950 more lives would be saved.

• If a new antiviral agent that improves rates of HCV eradication for patients with hard-to-treat genotypes 1/4 by 40% were to become available in 2010, 1500 more lives would be saved.

Based on these findings, the study authors concluded, "Current therapy is reducing HCV mortality. Therapeutic guidelines must take into account their impact on HCV mortality."

But, they noted, improvements in screening and development of better treatments could save significantly more lives in the future.

CTRS-INSERM U795, CHRU Lille, Lille, France; LEM-CNRS, Université Catholique de Lille, France.

9/12/08

Reference
S Deuffic-Burban, P Deltenre, A Louvet, and others. Impact of viral eradication on mortality related to hepatitis C: A modeling approach in France. Journal of Hepatology 49(20): 175-183. August 2008. (Abstract).