People who have been treated for chronic hepatitis C virus (HCV) infection—and cured—are less likely to die from non-liver-related health problems, according to an article published in the June 2011 issue of Clinical Gastroenterology and Hepatology.
Using medical records from the U.S. Veterans Administration, Lisa Backus, MD, PhD, of the VA Medical Center in Palo Alto, California, and her colleagues looked at the impact of achieving sustained virologic responses (SVRs)—when no HCV is detectable, or in other words, when the person is cured, six months after completing treatment—on survival among 16,684 veterans with chronic hepatitis C. More than 90 percent were male, most were older than 50, and many of them had other serious illnesses, including heart disease, chronic obstructive pulmonary disease, diabetes, cirrhosis, hypertension and depression. Cigarette smoking, heavy drinking and hard drug use were common.
HCV genotypes 1, 2 and 3 were included in this analysis. The SVR rate was 35 percent for genotype 1, 72 percent for genotype 2 and 62 percent for genotype 3.
Patients were followed for nearly four years after finishing treatment.
Backus’s group found that SVR lowered deaths from any cause across HCV genotypes. Having an SVR doubled five-year survival rates among people with HCV genotypes 1 and 2, and it tripled five-year survival rates among people with genotype 3.
The risk of death was greater for recent cigarette smokers, people with low platelets and people treated for a shorter duration. For genotypes 1 and 3, aging, diabetes, low albumin levels and an increased ratio of AST to ALT—both liver function tests—increased the risk of death, whereas in genotype 2, hypertension increased the risk of death.
As in this study, most people with HCV in the United States are older than 50 and are living with other medical conditions. The drop in death rates from any cause is an unexpected benefit from curing hepatitis C, especially because a recent study found that chronic hepatitis C doubles the risk of death from all causes.
This study underscores the importance of diagnosing and treating hepatitis C. HCV genotype 1 has become easier to cure with the approval of Incivek (telaprevir) and Victrelis (boceprevir). Adding one of these HCV protease inhibitors to pegylated interferon and ribavirin has boosted SVR rates to more than 70 percent, twice the rate in this study. The odds of a cure are also good for people with HCV genotypes 2 and 3; SVR rates range from 65 to 82 percent.
The authors concluded by suggesting that the benefits of SVR for people with hepatitis C and other medical conditions should overcome the reluctance to treat them, and that people with HCV should be encouraged to consider treatment, regardless of their genotype.