Hepatitis
C May Not Increase Mortality among Patients Who Are Not Coinfected, Do Not Drink
Heavily, and Do Not Have Cirrhosis
 |
Swiss patients with chronic hepatitis C virus (HCV) infection did not have a higher
risk of death compared with HCV-uninfected individuals in the absence of HIV or
hepatitis B coinfection, liver cirrhosis, drug injection, or excessive alcohol
consumption, researchers with the Swiss Hepatitis C Cohort Study Group reported
in the September
2009 Journal of Viral Hepatitis. |
|
The
investigators analyzed all-cause mortality among participants in the Swiss Hepatitis
C Cohort compared with the Swiss general population. The study included 1645 hepatitis
C patients receiving care at secondary and tertiary care centers in Switzerland.
Participants
were followed for more tan 2 years on average. The researchers calculated all-cause
standardized mortality ratios (SMRs) using patient sex, age, and calendar year
Swiss all-cause mortality rates. Multivariate Poisson regression analysis was
used to model the variability of SMRs according to cirrhosis status, HCV genotype,
HIV or hepatitis B coinfection, injection drug use, and alcohol consumption. Results  | A
total of 61 deaths were recorded among the 1645 cohort participants during the
follow-up period. | | The
crude all-cause SMR was 4.5 -- i.e., mortality was 4.5 times higher for hepatitis
C patients than for the general population. | | Patients
coinfected with HIV had a crude SMR of 20 -- or were 20 times more likely to die
than people with neither HCV or HIV. | | The
SMR was 1.1 -- essentially no difference in mortality -- for patients with the
following characteristics: | |
-Not coinfected with HIV or hepatitis B;
- Did not have cirrhosis;
- Had
HCV genotypes other than 3;
- Did not inject drugs;
- Not heavy alcohol
consumers (defined as < 40 g/day). |
|
"We
found little evidence of excess mortality in hepatitis C infected patients who
were not cirrhotic, in the absence of selected risk factors," the study authors
concluded. "Our findings emphasize the importance of providing appropriate
preventive advice, such as counseling to avoid alcohol intake, in those infected
with HCV." Institute
of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Swiss
Federal Office of Public Health, Division of Communicable Diseases, Vaccinations
Section, Bern, Switzerland; Services de Gastroentérologie et d'Hépatologie
et de Pathologie Clinique, Hôpitaux Universitaires, Genève, Switzerland;
CHUV, Swiss HIV Cohort Study, Lausanne-CHUV, Switzerland. 9/25/09 Reference
L
Prasad, VM Spicher, F Negro, and others. Little evidence that hepatitis C virus
leads to a higher risk of mortality in the absence of cirrhosis and excess alcohol
intake: the Swiss Hepatitis C Cohort Study. Journal of Viral Hepatitis
16(9): 644-649. September 2009. (Abstract).
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