Causes of death among persons diagnosed with hepatitis C infection in the pre‐ and post‐DAA era in England: A record linkage study

Simmons, Ruth; Ireland, Georgina; Ijaz, Samreen; Ramsay, Mary; Mandal, Sema

doi:10.1111/jvh.13096

Cited by 12 publications

(11 citation statements)

References 21 publications

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“…Similar results have been found in Italy, the United States (US) and Argentina [9-11]. A declining contribution of HCV-associated cirrhosis and cancer to transplants is helpful but is not a substitute for monitoring rates of HCV-associated transplants and may be limited by under-reporting of HCV coding in the liver transplant dataset, as has been observed in death registry data [12].…”

Section: Introductionsupporting

confidence: 65%

“…It is important to note that under-reporting of HCV-associated transplants is minimal, with only 3.2% of linked individuals having no record of HCV-associated disease or positive HCV tests in the transplant registry. This is much lower than the under-reporting with HCV-associated mortality in England, where 41% of persons who died of liver-related causes linked to an HCV laboratory diagnosis did not have HCV recorded as a contributory cause in the deaths registry [12]. A similar level of under-reporting in mortality was also identified in the US [25] and Scotland [26], with 41% and 52% of individuals who died of liver-related causes, respectively, having HCV indicated on their death certificate.…”

Section: Discussionmentioning

confidence: 99%

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Monitoring liver transplant rates in persons diagnosed with hepatitis C: a data linkage study, England 2008 to 2017

et al. 2019

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Liver transplantation is an important measure of burden from hepatitis C virus (HCV)associated liver disease. Aims: To describe transplant rates and survival in individuals with HCV infection from 2008 to 2017 in England through data linkage. Methods: This is a retrospective observational cohort study. Laboratory reports of HCV infection were linked to the Liver Transplant Registry for individuals aged 15 years and over, first diagnosed between 1998 and 2017. We estimated age-sex standardised incidence rates and used Poisson regression to investigate predictors of liver transplantation and test for a change in incidence after introduction of direct-acting antivirals (DAAs) in 2014. Kaplan-Meier survival analysis was used to calculate post-transplant survival rates. Results: Of 124,238 individuals diagnosed with HCV infection, 1,480 were registered and 1,217 received a liver transplant. Of individuals registered, 1,395 had post-HCV cirrhosis and 636 had hepatocellular carcinoma (618 also had post-HCV cirrhosis). Median time from HCV diagnosis to transplant was 3.4 years (interquartile range: 1.3-6.8 years). Liver transplant rates were lower 2014-17 compared with 2011-13 (incidence rate ratio: 0.64; 95% confidence interval: 0.55-0.76). Survival rates were 93.4%, 79.9% and 67.9% at 1, 5 and 10 years, respectively. Data linkage showed minimal under-reporting of HCV in the transplant registry. Conclusion: In the post-DAA era, liver transplant rates have fallen in individuals with HCV infection, showing early impact of HCV treatment scale-up; but the short time from HCV diagnosis to liver transplant suggests late diagnosis is a problem. License, supplementary material and copyright This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence and indicate if changes were made.

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Section: Introductionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Monitoring liver transplant rates in persons diagnosed with hepatitis C: a data linkage study, England 2008 to 2017

et al. 2019

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“…The expected decrease in mortality due to DAA is not occurring, or more probably not yet observable. Indeed, some studies have reported a decline in mortality after the introduction of DAA, but only from 2016 onwards [ 13 ]. As data for wider use of DAA were only available for 3 years (2014–2016), a period when prescription of DAA in Switzerland was limited based on fibrosis stage [ 24–26 ], we were not able to evaluate the difference between successful IFN treatment and successful DAA treatment regarding liver-related mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, few studies have analyzed detailed patterns of cause-specific mortality among HCV-infected persons [ 12 , 13 ]. We therefore investigated the risk factors and time trends for all-cause and cause-specific mortality among HCV-infected persons in the SCCS.…”

mentioning

confidence: 99%

All-Cause Mortality and Causes of Death in the Swiss Hepatitis C Cohort Study (SCCS)

Roelens

Bertisch

Moradpour

et al. 2020

Open Forum Infectious Diseases

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Background With direct-acting antiviral agents (DAA), mortality rates and causes of death among persons with hepatitis C virus (HCV) infection may change over time. However, the emergence of such trends may be delayed by the slow progression of chronic hepatitis C. To date, detailed analyses of cause-specific mortality among HCV-infected persons over time remain limited. Methods We evaluated changes in causes of death among the Swiss Hepatitis C Cohort Study (SCCS) participants, from 2008 to 2016. We analysed risk factors for all-cause and cause-specific mortality, accounting for changes in treatment, fibrosis stage and use of injectable drugs over time. Mortality ascertainment was completed by linking lost-to-follow-up participants to the Swiss Federal Statistical Office death registry. Results We included 4,700 SCCS participants, of whom 478 died between 2008 and 2016. The proportion of unknown causes of death decreased substantially after linkage, from 42% to 10%. Leading causes of death were liver failure (crude death rate 4.4/1000 person-years), liver cancer (3.4/1000 p-yrs) and non-liver cancer (2.8/1000 p-yrs), with an increasing proportion of cancer-related deaths over time. Cause-specific analysis showed that persons with sustained virologic response were less at risk for liver-related mortality than those never treated or treated unsuccessfully. Conclusions Although the expected decrease in mortality is not yet observable, causes of death among HCV-infected persons evolved over time. With the wider use of DAA, liver-related mortality is expected to decline in the future. Continued monitoring of cause-specific mortality will remain important to assess long-term effect of DAA and design effective interventions.

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“…The significance of confounding factors is clearly exemplified in a recent study by the same group where the median age of death was lower in persons with evidence of HCV than the general population (53 years vs 81 years). A significant proportion of persons with HCV died of external causes, liver disease and HIV compared to the general population[ 153 ].…”

Section: Hcv Infection: How Dangerous Is It Really?mentioning

confidence: 99%

Hepatitis C virus: A critical approach to who really needs treatment

Voumvouraki¹

2022

WJH

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Introduction of effective drugs in the treatment of hepatitis C virus (HCV) infection has prompted the World Health Organization to declare a global eradication target by 2030. Propositions have been made to screen the general population and treat all HCV carriers irrespective of the disease status. A year ago the new severe acute respiratory syndrome coronavirus 2 virus appeared causing a worldwide pandemic of coronavirus disease 2019 disease. Huge financial resources were redirected, and the pandemic became the first priority in every country. In this review, we examined the feasibility of the World Health Organization elimination program and the actual natural course of HCV infection. We also identified and analyzed certain comorbidity factors that may aggravate the progress of HCV and some marginalized subpopulations with characteristics favoring HCV dissemination. Alcohol consumption, HIV coinfection and the presence of components of metabolic syndrome including obesity, hyperuricemia and overt diabetes were comorbidities mostly responsible for increased liver-related morbidity and mortality of HCV. We also examined the significance of special subpopulations like people who inject drugs and males having sex with males. Finally, we proposed a different micro-elimination screening and treatment program that can be implemented in all countries irrespective of income. We suggest that screening and treatment of HCV carriers should be limited only in these particular groups.

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Causes of death among persons diagnosed with hepatitis C infection in the pre‐ and post‐DAA era in England: A record linkage study

Cited by 12 publications

References 21 publications

Monitoring liver transplant rates in persons diagnosed with hepatitis C: a data linkage study, England 2008 to 2017

Monitoring liver transplant rates in persons diagnosed with hepatitis C: a data linkage study, England 2008 to 2017

All-Cause Mortality and Causes of Death in the Swiss Hepatitis C Cohort Study (SCCS)

Hepatitis C virus: A critical approach to who really needs treatment

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