TOPLINE:
Adults successfully treated for hepatitis C virus (HCV) infection still face a substantially greater risk for death compared with the general population. Liver- and drug-related causes of death were the main drivers of excess mortality.
METHODOLOGY:
- Researchers quantified mortality rates after HCV cure in the era of interferon-free direct-acting antivirals and compared them with those in the general population.
- Data were analyzed from population studies carried out in British Columbia, Canada; Scotland; and England for 21,790 adults who achieved HCV cure between 2014 and 2019, with linkage to national registries.
- Patients were divided into three groups on the basis of their liver disease severity at the time of cure: pre-cirrhosis, compensated cirrhosis, and end-stage liver disease.
- Follow-up started 12 weeks after antiviral treatment completion and ended on date of death or December 31, 2019.
TAKEAWAY:
- A total of 1572 (7%) participants died during follow-up. The leading causes of death were drug-related mortality (24%), liver failure (18%), and liver cancer (16%).
- After accounting for age, sex, and year, death rates were 3-14 times higher than the general population, depending on the liver disease stage.
- Across all disease stages and settings, older age, recent substance use, alcohol use, and comorbidities were associated with higher mortality.
IN PRACTICE:
"These findings highlight the need for continued support and follow-up after successful treatment for [HCV] to maximize the impact of direct acting antivirals," the authors write. "Additionally, our data suggest patients need more support to reduce drug and alcohol misuse after HCV cure."
SOURCE:
The study, with first author Victoria Hamill, PhD, of Glasgow Caledonian University, United Kingdom, was funded by Medical Research Foundation. It was published online August 2 in The BMJ.
LIMITATIONS:
All patients were from high-income countries where HCV transmission is driven by injection drug use. The results may not generalize to settings where the epidemiology differs. The analysis did not directly account for HCV reinfection after cure.
DISCLOSURES:
Hamill has no relevant disclosures. Some authors report honoraria and consulting fees from pharmaceutical companies.
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