Suppressing Hepatitis C Virus Saves Lives -- When Possible

Reducing hepatitis C viral load substantially reduces the risk of mortality. Unfortunately, using drugs other than the (expensive) new direct acting antivirals, few patients achieved effective treatment.

McCombs J, Matsuda T, Ivy Tonnu-Mihara I, et al.The Risk of Long-term Morbidity and Mortality in Patients With Chronic Hepatitis C: Results From an Analysis of Data From a Department of Veterans Affairs Clinical Registry (2014) JAMA Intern Med.;174(2):204-212. doi:10.1001/jamainternmed.2013.12505.

Katz MH. Hepatitis C Treatment: Stuck Between a Rock and a Hard Place but Hoping to Be Rescued Soon (2014) JAMA Intern Med.;174(2):212. doi:10.1001/jamainternmed.2013.12418

A large observational study has found that attaining an undetectable viral load of hepatitis C virus (HCV) lowered the risk of death by about half.

However, only 24.3% of patients in this study actually received treatment, and only 16.4% achieved an undetectable viral load. Treatment included interferon, boceprevir, or telaprevir.

These results, says a commentary, will be even more significant if the new direct-acting antiviral drugs can achieve sustained viral suppression in a high percentage of patients without serious adverse effects (and without “breaking the bank”).

The study followed 128,769 patients in the US Department of Veterans Affairs clinical case registry, a large, real-world practice sample.

The primary outcomes were all-cause mortality and a composite of cirrhosis, hepatocellular carcinoma, or liver-related hospitalization.

The unadjusted death rates were 6.8/1,000 person-years for those who achieved viral load suppression vs 21.8 for those who did not.

The study gave primary and secondary outcomes in many subsets, including race, HCV genotype, diabetes, and treatment type, and was powered to give relative risks that were statistically significant (p<0.001) and more precise than earlier studies. For example, the hazard ratio for all-cause mortality was 0.80 for genotype 2 (confidence interval [CI] 0.76-0.84) compared to genotype 1; for genotype 3 it was 1.17 (CI 0.1.11-1.24). Black patients had a lower risk of death than white patients (15.8 [15.3-16.4] per 1,000 vs 22.2 [21.7-22.7]).