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Mortality in HCV patients after SVR still higher than general population
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Scottish patients with hepatitis C who achieved sustained virologic response had a mortality rate that remained higher than the general population, according to recent findings published in the Journal of Hepatology.
“The excess was mainly driven by death from liver cancer and death from drug-related causes,” Hamish Innes, MSc, epidemiologist at the School of Health and Life Sciences at Glasgow Caledonian University in the U.K., and colleagues wrote. “A history of heavy alcohol use and injecting drug use were associated with a higher mortality risk.”
While the number of people with HCV who attain sustained virologic response is expected to increase quickly, the prognosis for this group compared with the general population is unknown, the researchers wrote.
Therefore, Innes and colleagues identified 1,824 patients who achieved SVR in Scotland between 1996 and 2011 (mean follow-up, 5.2 years) using a national database, and then collected data on cause-specific mortality. They calculated standardized mortality ratios (SMRs) comparing the frequency of mortality in these patients with the general population. Using Cox regression analysis, they identified modifiable patient traits associated with post-SVR mortality.
The researchers observed 78 deaths. All-cause mortality was 1.86 times (95% CI, 1.49-2.32) more frequent for patients who achieved SVR than the general population. Primary liver cancer deaths (SMR = 23.5; 95% CI, 12.23-45.16) and drug-related deaths (SMR = 6.58; 95% CI, 4.15-10.45) also were elevated in this population. These two causes accounted for 66% of the total excess death. All modifiable characteristics associated with post-SVR mortality were markers of either heavy alcohol use and injecting drug use, the researchers said. Patients without these characteristics, which represent 32.8% of this cohort, had similar mortality to the general population (SMR = 0.7; 95% CI, 0.41-1.18).
The researchers concluded that health risk behaviors were important modifiable determinants of mortality.
“To minimize the post-SVR risk for [hepatocellular carcinoma], careful and prudent staging of liver fibrosis should be performed prior to discharge to identify those patients who might benefit from regular screening,” the researchers wrote. “Arguably, more research is needed to bottom out more precisely which SVR patients stand to benefit from such surveillance.” – by Will Offit
Disclosure: Innes reports receiving personal fees from Gilead Sciences. Please see the full study for a list of all other authors’ relevant financial disclosures.
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