Mortality in patients with chronic and cleared hepatitis C viral infection: a nationwide cohort study

TY - JOUR

T1 - Mortality in patients with chronic and cleared hepatitis C viral infection: a nationwide cohort study

AU - Omland, Lars Haukali

AU - Krarup, Henrik

AU - Jepsen, Peter

AU - Georgsen, Jørgen

AU - Harritshøj, Lene Holm

AU - Riisom, Kirsten

AU - Jacobsen, Svend Erik Hove

AU - Schouenborg, Per

AU - Christensen, Peer Brehm

AU - Sørensen, Henrik Toft

AU - Obel, Niels

AU - Bangsborg, Jette Marie

AU - DANVIR Cohort Study

N1 - Copyright 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

PY - 2010/7/1

Y1 - 2010/7/1

N2 - Background & Aims: It is unknown whether mortality differs between patients with chronic hepatitis C virus (HCV) replication and those who cleared the virus after infection. We examined the impact of chronic HCV replication on mortality among Danish patients testing positive for HCV antibodies. Methods: This nationwide cohort study focused on Danish patients with at least one HCV RNA measurement available after testing positive for HCV antibodies between 1996 and 2005. To capture long-term prognosis, eligible patients needed to be alive 1 year after HCV RNA assessment. We estimated mortality rate ratios (MRRs) using Cox regression (for overall mortality) and subdistribution hazard ratios (SDHRs) for cause-specific mortality, controlling for gender, age, comorbidity, calendar period, alcohol abuse, injection drug use, and income. Results: Of the 6292 patients under study, 63% had chronic HCV-infection and 37% had cleared the virus. Five-year survival was 86% (95% confidence interval (CI): 84-87%) in the chronic HCV group and 92% (95% CI: 91-94%) in the cleared HCV group. Chronic HCV-infection was associated with higher overall mortality (MRR: 1.55, 95% CI: 1.28-1.86) and liver-related death (SDHR: 2.42, 95% CI: 1.51-3.88). Chronic HCV-infection greatly increased the risk of death from primary liver cancer (SDHR: 16.47, 95% CI: 2.24-121.00). Conclusions: Patients with chronic HCV-infection are at higher risk of death than patients who cleared the infection. The substantial association found between chronic HCV-infection and death from primary liver cancer supports early initiation of antiviral treatment in chronically HCV-infected patients.

AB - Background & Aims: It is unknown whether mortality differs between patients with chronic hepatitis C virus (HCV) replication and those who cleared the virus after infection. We examined the impact of chronic HCV replication on mortality among Danish patients testing positive for HCV antibodies. Methods: This nationwide cohort study focused on Danish patients with at least one HCV RNA measurement available after testing positive for HCV antibodies between 1996 and 2005. To capture long-term prognosis, eligible patients needed to be alive 1 year after HCV RNA assessment. We estimated mortality rate ratios (MRRs) using Cox regression (for overall mortality) and subdistribution hazard ratios (SDHRs) for cause-specific mortality, controlling for gender, age, comorbidity, calendar period, alcohol abuse, injection drug use, and income. Results: Of the 6292 patients under study, 63% had chronic HCV-infection and 37% had cleared the virus. Five-year survival was 86% (95% confidence interval (CI): 84-87%) in the chronic HCV group and 92% (95% CI: 91-94%) in the cleared HCV group. Chronic HCV-infection was associated with higher overall mortality (MRR: 1.55, 95% CI: 1.28-1.86) and liver-related death (SDHR: 2.42, 95% CI: 1.51-3.88). Chronic HCV-infection greatly increased the risk of death from primary liver cancer (SDHR: 16.47, 95% CI: 2.24-121.00). Conclusions: Patients with chronic HCV-infection are at higher risk of death than patients who cleared the infection. The substantial association found between chronic HCV-infection and death from primary liver cancer supports early initiation of antiviral treatment in chronically HCV-infected patients.

KW - Adult

KW - Cohort Studies

KW - Denmark

KW - Female

KW - Hepacivirus

KW - Hepatitis C

KW - Hepatitis C, Chronic

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - RNA, Viral

KW - Virus Replication

U2 - 10.1016/j.jhep.2010.01.033

DO - 10.1016/j.jhep.2010.01.033

M3 - Journal article

C2 - 20400197

SN - 0168-8278

VL - 53

SP - 36

EP - 42

JO - Journal of Hepatology

JF - Journal of Hepatology

IS - 1

ER -