People who have been cured of hepatitis C remain at higher
risk of dying from liver-related causes than the general population, but their
risk of cardiovascular events goes down after being cured, large studies in the
United Kingdom, Canada and France have concluded.
The study carried out in the United Kingdom and Canada also found that compared to the
rest of the population, people cured of hepatitis C remain at higher risk of
dying from drug-related causes such as overdose.
The findings were presented at the 2022 International Liver
Congress in London.
- compensated cirrhosis
The earlier stage of
cirrhosis, during which the liver is damaged but still able to perform most of
its functions. See also ‘cirrhosis’ and ‘decompensated cirrhosis’.
Something that has an
effect outside the liver, for example when viral hepatitis affects the kidneys
or causes depression.
A study carried out in England, Scotland and the Canadian
province of British Columbia looked at death rates in 20,031 people cured of
hepatitis C compared to mortality in the general population in each territory.
The study also looked at the proportion of deaths in people cured of hepatitis
C that were attributable to liver cancer, liver-related causes other than
cancer, or drug-related causes.
Mortality rates were assessed according to liver disease stage
(no cirrhosis, compensated cirrhosis or end-stage liver disease) and
standardised to reflect the age-sex distribution in each cohort.
On average, participants were followed for between two and
four years after being cured, depending on which national cohort they belonged
Mortality rates ranged from 11.7 per 1000 person-years in people
without cirrhosis in the Scottish cohort to 118.2 deaths per 1000 person-years
in people with end-stage liver disease in British Columbia.
Presenting the findings, Dr Victoria Hamill of Glasgow
Caledonian University said that these rates showed that approximately 1.2% of the
Scottish cohort without cirrhosis died each year, whereas 12% of the British
Columbia cohort with end-stage liver disease died each year.
When the researchers looked at excess deaths – how much the
death rate in people cured of hepatitis C exceeded the death rate in the
regional population with similar characteristics – they found that mortality
rates were approximately three-and-a-half times higher in people without cirrhosis
cured of hepatitis C. Death rates were four to five times higher in people with
compensated cirrhosis and between eight and 15 times higher in people with end-stage
liver disease, depending on the cohort.
In Scotland, the cause of death was more often drug-related
than liver-related in people without cirrhosis or compensated cirrhosis.
Seventy-seven per cent of deaths in people without cirrhosis in Scotland were
In England and British Columbia, the cause of death was more
often liver-related in people with compensated cirrhosis and in all cohorts,
the cause of death was predominantly liver-related in people with end-stage liver
Dr Hamill said the findings demonstrated the need for a range
of post-cure interventions including harm reduction services for people who use
drugs, overdose prevention and ongoing monitoring of liver health.