Infection with
hepatitis C virus (HCV) has a significant impact on life expectancy, results of
two US studies published in the online edition of Clinical Infectious Diseases show. In New York City, 94% of people dying with HIV and HCV co-infection were under the age of 65, and an
analysis of the death certificate records of people enrolled in a large
cohort study showed that people with HCV were dying an average of 15 years
earlier than individuals without the infection.
The New York study
“convincingly” demonstrated the “increased risk of premature mortality…in
patients infected with hepatitis C,” writes the author of an accompanying
editorial, who also notes that the second study “found a significantly higher
than expected effect of hepatitis C on mortality.”
The HCV epidemic
is especially severe in New York City, where an estimated 146,000 residents are
living with the virus. Investigators wished to determine the impact of HCV
on mortality in the city and to determine the causes of death in people dying
with HCV.
The investigators
found that 13,307 adults with HCV mono-infection and 5475 adults with HIV and HCV
co-infection died in the city between 2000 and 2011.
Almost two-thirds
(64%) of people with HCV mono-infection and 94% of people with HIV and HCV
co-infection died before the age of 65 – a premature death. In contrast, there
was a 25% premature death rate among people with neither infection.
The median ages at
death for people with HCV mono-infection and HIV and HCV co-infection were 60 and
52 years, respectively. This compared to a median age of death of 78 years for people with neither infection.
The most common
causes of death in people with HCV mono-infection were cardiovascular disease
(26%), non-liver cancer (16%), HCV infection (12%), liver cancer (9%) and
drug-related causes (8%). The majority of deaths (54%) in people with HIV and HCV co-infection
were attributed to HIV-related causes.
People with HCV
mono-infection were more likely than people who didn't have HCV to die of liver
cancer, drug-related causes and cirrhosis (all p < 0.05). Comparison with
people who didn't have co-infection showed that people with HIV and HCV co-infection had an increased risk of
death due to liver cancer and drug-related causes (both p < 0.05).
“These findings
suggest that there is much work to be done to improve outcomes for patients
with HCV in NYC,” write the authors.
The second study used
death certificates to compare causes of death between people enrolled in the
observational Chronic Hepatitis Cohort Study (CHeCS) and the general US population.
The period of analysis was 2006-2010.
Over 2,140,000 people received care at CHeCS sites during the study period; 11,703 (0.5%) of
these patients were infected with HCV and 1590 (14%) of the patients with HCV died.
Three-quarters of
those dying with HCV were born between 1945 and 1965, half were white and 68% were
men. The mean age at death was 58 years. This was 15 years younger than the
mean age of death among the general US population.
Before death, 63%
of CHeCS patients had evidence of chronic liver disease and 76% had severe
fibrosis. However, less than a fifth (19%) of CHeCS
patients with HCV who died had had liver disease listed on their death certificates. Liver
disease was mentioned on 47% of death certificates, but of these, only 41%
specifically mentioned HCV.
“Data from this
study suggests a much greater role for HCV mortality in the United States than
has been previously understood based on death certificate data,” comment the
investigators. “Our results may be a conservative estimate as recent studies
estimate that only about half of all HCV-infected persons have been diagnosed.”