Changing trends in complications of chronic hepatitis C

Lü, Mei; Li, Jia; Rupp, Loralee B; Zhou, Yueren; Holmberg, Scott D.; Moorman, Anne C.; Spradling, Philip R.; Teshale, Eyasu H.; Boscarino, Joseph A.; Daida, Yihe G.; Schmidt, Mark; Trudeau, Sheri; Gordon, Stuart C.

doi:10.1111/liv.13501

Cited by 12 publications

(9 citation statements)

References 28 publications

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“…This observation is consistent with recent studies that have demonstrated higher rates of cirrhosis among black and Hispanic patients and lower HCV treatment rates among racial minorities. (11–13) This trend also parallels the racial trends of LT overall, which may represent improved access to LT for minorities, who have been historically disadvantaged. (14–15)…”

Section: Discussionmentioning

confidence: 74%

Decreasing mortality and disease severity in hepatitis C patients awaiting liver transplantation in the United States

et al. 2018

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Hepatitis C virus (HCV) infection has been the leading indication for liver transplantation (LT) in the United States. Since 2013, interferon-free antiviral therapy has led to sustained virological response in many LT candidates. We compared the wait-list mortality of HCV patients with that of patients with other chronic liver diseases. Data for primary LT candidates were obtained from the Organ Procurement and Transplantation Network database. Adult wait-list registrants were divided into 3 cohorts: cohort 1 included patients on the waiting list as of January 1, 2004; cohort 2 as of January 1, 2009; and cohort 3 as of January 1, 2014. The primary outcome was wait-list mortality, and the secondary outcome was the rate of change in Model for End-Stage Liver Disease (MELD). Multivariate Cox proportional hazards analysis was performed to evaluate 12-month wait-list mortality. The cohorts included 7627 LT candidates with HCV and 13,748 patients without HCV. Compared with cohort 2, HCV patients in cohort 3 had a 21% lower risk of death (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.67-0.93). Among patients with non-HCV liver disease, no difference in mortality was seen between cohorts 2 and 3 (HR, 0.97; 95% CI, 0.86-1.09). Among HCV patients, the mean rate of change in MELD decreased from 2.35 per year for cohort 2 to 1.90 per year for cohort 3, compared with 1.90 and 1.66 in cohorts 2 and 3, respectively, among non-HCV patients. In this population-based study, wait-list mortality and progression of disease severity decreased in recent HCV patients for whom direct-acting antiviral agents were available. Liver Transplantation 24 735-743 2018 AASLD.

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Section: Discussionmentioning

confidence: 74%

Decreasing mortality and disease severity in hepatitis C patients awaiting liver transplantation in the United States

et al. 2018

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“…Approximately 2.4 million US individuals are currently infected with the hepatitis C virus (HCV) 1 and 28% of those with chronic HCV have cirrhosis. 2 Annually 1% to 4% of individuals with cirrhosis will develop liver cancer. 3 Antiviral treatments for HCV previously required a combination of agents taken over 24 to 48 weeks, were associated with significant adverse effects, and were effective in 54% to 63% of patients who completed treatment.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Safety of Direct-Acting Antiviral Agents for Hepatitis C

et al. 2019

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Key Points Question Are patients with hepatitis C who receive direct-acting antivirals at increased risk for adverse events compared with those who do not receive these agents? Findings In this cohort study of 33 808 patients in 3 health systems, direct-acting antiviral exposure was associated with lower odds of experiencing the following adverse events: death, multiple organ failure, hepatic decompensation, acute-on-chronic liver event, and arrhythmia. Meaning Concerns about safety risks based on analyses of the US Food and Drug Administration’s Adverse Events Reporting System did not appear to be confirmed, suggesting that dispensed direct-acting antivirals may be safe for patients with hepatitis C.

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“…First, because infection with HCV is primarily asymptomatic, undiagnosed baby boomers are experiencing the downstream effects of the disease decades later. Recent analyses have revealed an increase in two critical HCV‐related outcomes, cirrhosis and hepatocellular carcinoma . Second, injection drug use, the predominant risk for HCV transmission, has increased in concert with the nation’s opioid epidemic .…”

mentioning

confidence: 99%

“…Recent analyses have revealed an increase in two critical HCV-related outcomes, cirrhosis and hepatocellular carcinoma. (6,7) Second, injection drug use, the predominant risk for HCV transmission, has increased in concert with the nation's opioid epidemic. (8) Moreover, among persons successfully treated and cured, active drug injection poses a major risk of reinfection.…”

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confidence: 99%

The Hepatitis C Virus Care Continuum: Linkage to Hepatitis C Virus Care and Treatment Among Patients at an Urban Health Network, Philadelphia, PA

Coyle

Moorman

Bartholomew³

et al. 2019

Hepatology

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Improving care and treatment for persons infected with hepatitis C virus (HCV) can reduce HCV‐related morbidity and mortality. Our primary objective was to examine the HCV care continuum among patients receiving care at five federally qualified health centers (FQHCs) in Philadelphia, PA, where a testing and linkage to care program had been established. Among the five FQHCs, one served a homeless population, two served public housing residents, one served a majority Hispanic population, and the last, a “test and treat” site, also provided HCV treatment to patients. We analyzed data from electronic health records of patients tested for HCV antibody from 2012 to 2016 and calculated the percentage of patients across nine steps of the HCV care continuum ranging from diagnosis to cure. We further explored factors associated with successful patient navigation through two steps of the continuum using multivariable logistic regression. Of 885 chronically infected patients, 92.2% received their RNA‐positive result, 82.7% were referred to an HCV provider, 69.4% were medically evaluated by the provider, 55.3% underwent liver disease staging, 15.0% initiated treatment, 12.0% completed treatment, 8.7% were assessed for sustained virologic response (SVR), and 8.0% achieved SVR. Regression results revealed that test and treat site patients were significantly more likely to be medically evaluated (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.82‐4.17) and to undergo liver disease staging (aOR, 1.92; 95% CI, 1.02‐2.86) than patients at the other FQHCs combined. Conclusion: In this US urban setting, over two thirds of HCV‐infected patients were linked to care; although treatment uptake was low overall, it was highest at the test and treat site; scaling up treatment services in HCV testing settings will be vital to improve the HCV care continuum.

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Changing trends in complications of chronic hepatitis C

Abstract: Although cirrhosis and mortality among HCV-infected patients in the US have increased over the past decade, all-cause mortality has decreased in recent years.

Cited by 12 publications

References 28 publications

Decreasing mortality and disease severity in hepatitis C patients awaiting liver transplantation in the United States

Decreasing mortality and disease severity in hepatitis C patients awaiting liver transplantation in the United States

Assessing the Safety of Direct-Acting Antiviral Agents for Hepatitis C

The Hepatitis C Virus Care Continuum: Linkage to Hepatitis C Virus Care and Treatment Among Patients at an Urban Health Network, Philadelphia, PA

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