Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population.
BACKGROUND & AIMS
The number of people living with previous hepatitis C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear.


METHODS
Individuals attaining SVR in Scotland in 1996-2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised mortality ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality.


RESULTS
We identified 1824 patients, followed on average for 5.2years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% confidence interval (CI): 1.49-2.32). Significant cause-specific elevations were seen for death due to primary liver cancer (SMR: 23.50; 95% CI: 12.23-45.16), and death due to drug-related causes (SMR: 6.58, 95% CI: 4.15-10.45). Together these two causes accounted for 66% of the total excess death observed. All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (SMR: 0.70; 95% CI: 0.41-1.18) CONCLUSIONS: Mortality in Scottish SVR patients is higher overall than the general population. The excess was driven by death from drug-related causes and liver cancer. Health risk behaviours emerged as important modifiable determinants of mortality in this population.


LAY SUMMARY
Patients cured of hepatitis C through treatment had a higher mortality rate overall than the general population. Most of the surplus mortality was due to drug-related causes and death from liver cancer. A history of heavy alcohol and injecting drug use were associated with a higher mortality risk.
['Innes|Hamish|H|', 'McDonald|Scott|S|', 'Hayes|Peter|P|', 'Dillon|John F|JF|', 'Allen|Sam|S|', 'Goldberg|David|D|', 'Mills|Peter R|PR|', 'Barclay|Stephen T|ST|', 'Wilks|David|D|', 'Valerio|Heather|H|', 'Fox|Ray|R|', 'Bhattacharyya|Diptendu|D|', 'Kennedy|Nicholas|N|', 'Morris|Judith|J|', 'Fraser|Andrew|A|', 'Stanley|Adrian|A|', 'Bramley|Peter|P|', 'Hutchinson|Sharon J|SJ|']
D000328:Adult D000368:Aged D000998:Antiviral Agents D002423:Cause of Death D016208:Databases, Factual D005260:Female D019698:Hepatitis C, Chronic D006801:Humans D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D009026:Mortality D011379:Prognosis D012307:Risk Factors D012606:Scotland D000072230:Sustained Virologic Response
Hepatitis C Cure Epidemiology Excess mortality