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Reuters Health Information (2009-08-04): HCV carriers have elevated mortality risk


HCV carriers have elevated mortality risk

Last Updated: 2009-08-04 17:32:08 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Individuals infected with hepatitis C virus (HCV) have higher mortality rates than uninfected individuals, the results of two studies published in the August issue of Hepatology confirm.

In one study, researchers followed 1125 anti-HCV-seropositive individuals from an HCV hyperendemic area of Japan for 10 years (1995-2005). Of the total, 758 (67.4%) were HCV carriers, having detectable HCV core antigen (HCVcAg) or HCV RNA, and 367 (32.6%) were not carriers, having prior HCV infection but now negative for HCVcAg and HCV RNA. The subjects were approximately 64 years old at enrollment.

During an average of 8.2 years, a total of 231 study subjects died, with 176 deaths occurring in the HCV carrier group and 55 in the non-carrier group. In analyses adjusted for age and sex, the hazard ratio for death was 1.53 in HCV carriers compared to non-carriers.

The 10-year cumulative risk of death was 28.0% for the HCV carriers and 17.9% for HCV noncarriers, a statistically significant difference (p < 0.001), Dr. Hirofumi Uto, of Kagoshima University Graduate School of Medical and Dental Sciences, and colleagues report.

The elevated mortality rate among HCV carriers was due to a much higher occurrence of liver-related deaths, but was not significantly associated with death from other malignancies, stroke, heart disease, or pulmonary disease, they note.

Among HCV carriers, high HCVcAg levels (100 pg/mL or greater) and persistently elevated alanine aminotransferase (ALT) levels were "important predictors of liver-related mortality," they point out.

"Monitoring HCV load and ALT level in HCV carriers may be important for identifying those individuals at increased risk for hepatocellular carcinoma or other liver disease, particularly among older carriers who are less likely to respond to HCV treatment," Dr. Uto and colleagues conclude.

In their study, Dr. Adeel A. Butt from University of Pittsburgh School of Medicine in Pennsylvania and colleagues report evidence confirming that HCV infection is associated with increased mortality.

In a national sample of 34,480 HCV-infected subjects versus a non-infected control sample, they found that HCV infection was independently associated with a higher risk of mortality (hazard ratio, 1.37).

Dr. Butt's team also found that treatment for HCV was associated with a significant decrease in mortality. Patients who received at least 48 weeks of treatment had the lowest mortality (HR, 0.41), while those who received less than 48 weeks of treatment had intermediate mortality (HR, 0.71), compared with untreated individuals.

"Strategies to identify appropriate candidates for treatment, and to ensure completion of treatment may substantially reduce mortality in HCV infected persons," Dr. Butt and colleagues conclude.

Hepatology 2009;50:349-351,387-399.

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