Mortality rates among patients with hepatitis C who achieved sustained viral responses with interferon-free, direct-acting antiviral agents are higher than in the general population, researchers report, pointing to a need for continued support and follow-up after treatment. The main drivers of excess mortality identified in a population-based, cohort study were drug- and liver-related factors.
In British Columbia, Scotland, and England, 21,790 people who were successfully treated for hepatitis C in 2014-19 were grouped as being without cirrhosis (pre-cirrhosis), having compensated cirrhosis, and having end-stage liver disease. Crude and age-sex standardized mortality rates and standardized mortality ratios compared the number of deaths among patients with figures for the general population.
“1,572 (7%) participants died during follow-up,” the authors write. “The leading causes of death were drug related mortality (n = 383, 24%), liver failure (n = 286, 18%), and liver cancer (n = 250, 16%). Crude all cause mortality rates (deaths per 1,000 person years) were 31.4 (95% confidence interval 29.3 to 33.7), 22.7 (20.7 to 25.0), and 39.6 (35.4 to 44.3) for cohorts from British Columbia, Scotland, and England, respectively. All cause mortality was considerably higher than the rate for the general population across all disease severity groups and settings; for example, all cause mortality was three times higher among people without cirrhosis in British Columbia (standardised mortality ratio 2.96, 95% confidence interval 2.71 to 3.23; P <0.001) and more than 10 times higher for patients with end stage liver disease in British Columbia (13.61, 11.94 to 15.49; P <0.001). In regression analyses, older age, recent substance misuse, alcohol misuse, and comorbidities were associated with higher mortality rates.”