People with hepatitis C cure still face risk of death: Study

UNITED STATES: Even after being cured of hepatitis C, those who recover have a much higher chance of dying than the general population—between three and fourteen times higher, depending on the severity of their liver illness. The study's findings were published in The BMJ.

The findings, based on a database of over 20,000 people who have been cured of hepatitis C, show that drug- and liver-related causes of death accounted for the majority of excess fatalities. This emphasises the importance of ongoing assistance in reaping the full benefits of a hepatitis C cure. Hepatitis C is a virus that can infect the liver and cause significant and potentially fatal liver damage over time if treatment is not received.

Historically, interferon-based therapy was used to treat hepatitis C, which was frequently ineffective. However, new medications known as direct-acting antivirals (DAA) were developed in 2011. More than 95 per cent of DAA-treated patients now achieve a "virological cure" and have a significantly lower risk of death than untreated patients. However, the question of what prognosis cured patients can expect in comparison to the general population is still being debated.

To investigate further, a team of UK and Canadian researchers set out to measure mortality rates in people who had a hepatitis C cure and compare them to the general population. They examined data from three population studies conducted in British Columbia (Canada), Scotland, and England involving 21,790 people who were cured of hepatitis C between 2014 and 2019.

Individuals were divided into three groups based on the severity of their liver disease at the time of cure: pre-cirrhosis (only in the British Columbia and Scotland studies), compensated cirrhosis, and end-stage liver disease. Over an average follow-up period of 2-4 years, data were linked to national medical registries and several causes of death were examined, including liver cancer, liver failure, drug-related death, external causes (primarily accidents, homicides, and suicides), and circulatory system diseases.

After age was taken into account, death rates were significantly higher than in the general population across all disease severity groups and settings. In Scotland, for example, the rate for all patients was 4.5 times higher than the general population (442 deaths observed versus 98 expected), whereas rates in British Columbia were 3.9 times higher (821 deaths observed versus 209 expected).

Rates also increased significantly with the severity of the liver disease. In British Columbia, for example, rates were three times higher in people without cirrhosis and fourteen times higher in patients with end-stage liver disease. The leading cause of excess death in patients without cirrhosis was drug-related, whereas the two leading drivers in patients with cirrhosis were liver cancer and liver failure.

Older age, recent substance use, alcohol use, and pre-existing conditions (comorbidities) were all associated with higher death rates across all disease stages and settings. These are preliminary findings, and the researchers acknowledge that they may not be applicable in all settings, particularly where injecting drug use is not the predominant mode of hepatitis C transmission.