Hepatitis C Increases Mortality, but Successful Treatment Improves Survival

A study of U.S. veterans indicates that people with hepatitis C virus (HCV) infection have substantially higher mortality compared with uninfected individuals, but those who complete interferon-based treatment significantly reduce their risk of death, according to a study in the August 2009 issue of Hepatology.

The effect of hepatitis C on mortality is not fully understood, due to conflicting data. While a majority of research indicates that HCV has a negative effect on survival, one recent study found that hepatitis C itself did not increase the risk of death among patients who were not coinfected with hepatitis B or HIV, did not drink heavily, and did not have liver cirrhosis.

Adeel Butt from the University of Pittsburgh and colleagues evaluated the effect of hepatitis C and its treatment on survival among 34,480 matched pairs of HCV-infected and uninfected U.S. veterans, using a national sample from the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES) database.

The investigators compared survival in the groups with and without hepatitis C, and looked at the effect of treatment initiation and treatment duration on survival in the HCV group. Kaplan-Meier survival plots were generated to compare survival between HCV-infected and HCV-uninfected individuals, and between treated and untreated HCV patients.

Results

	HCV infection was independently associated with a higher risk of mortality (hazard ratio 1.37).
	Patients who received hepatitis C treatment for 48 weeks or longer had the lowest mortality rate among HCV-infected participants (hazard ratio 0.41).
	Individuals treated for less than 48 weeks had an intermediate mortality rate between untreated patients and those treated for the full duration:
	- Hazard ratio 0.71 for 0-23 weeks of treatment; - Hazard ratio 0.60 for 24-47 weeks of treatment.

"HCV infection is associated with a substantial increase in mortality," the study authors concluded. "Subjects who are initiated on treatment, and particularly those who proceed to finish a full course of treatment, have significantly reduced risk of mortality."

University of Pittsburgh School of Medicine, Pittsburgh, PA; Veterans Administration (VA) Pittsburgh Healthcare System, Pittsburgh, PA; Center for Health Equity Research and Promotion, Pittsburgh, PA.

9/29/09

Reference
AA Butt, X Wang, and CG Moore. Effect of hepatitis C virus and its treatment on survival. Hepatology 50(2): 387-392. August 2009. (Abstract).