Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
BACKGROUND & AIMS:
There have been few studies of the effects of pre-treatment anemia on outcomes of patients with chronic hepatitis C virus (HCV) infection. Anemic individuals are less likely to receive treatment for HCV infection because hemolytic anemia is a frequent side-effect of therapies. We investigated the effects of HCV therapy on mortality of patients with chronic HCV infection and anemia.
We performed a retrospective analysis of 200,139 HCV-infected Veterans using data from the Electronically Retrieved Cohort of Hepatitis C-Infected Veterans (2001-2008). The effects of treatment and treatment duration upon survival were compared based on data from 1820 treated and 27,690 untreated anemic HCV-infected Veterans. The association between HCV treatment and mortality was estimated using Cox proportional hazard models, with adjustments for potential confounders. The main outcome was all-cause mortality.
In multivariable analysis, pre-treatment anemia was significantly associated with African-American race (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.95-2.11), chronic kidney disease (OR, 3.36; 95% CI, 3.23-3.51), and decompensated liver disease (OR, 3.69; 95% CI, 3.53-3.86). All-cause mortality for treated, anemic, HCV-infected Veterans was lower (54.2/1000 person-years; 95% CI, 49.2-59.7/1000 person years) than for untreated, anemic HCV-infected Veterans (146.8/1000 person-years; 95% CI, 144.2-149.4/1000 person-years). The adjusted hazards ratio (HR) for treatment of HCV in anemic Veterans was 0.45 (95% CI, 0.39-0.51), which was reduced after exclusion of co-morbidities (HR, 0.28; 95% CI, 0.22-0.37).
Based on a retrospective analysis of a Veterans database, HCV therapy increases survival of individuals with pre-treatment anemia. Additional studies are needed to determine strategies to increase rates of HCV therapy for this group.